Ergonomic surgical instruments

ABSTRACT

A surgical instrument comprising a trigger configured to be actuated by a proximally directed force and by a distally directed force. The trigger may comprise a proximal trigger portion having a first length and a distal trigger hook comprising a distal portion having a second length. The second length may be less than the first length. The distal trigger hook may be coupled to the proximal trigger portion.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.12/245,158, filed Oct. 3, 2008 and entitled, “Ergonomic SurgicalInstruments,” which is hereby incorporated by reference in its entiretyand which claims the benefit under Title 35, United States Code §119(e),of U.S. Patent Provisional Application Ser. No. 60/997,901, filed Oct.5, 2007 and entitled “Ergonomic Ultrasonic Surgical Instruments,” whichis hereby incorporated by reference in its entirety.

BACKGROUND

Ultrasonic surgical instruments, including both hollow core and solidcore instruments, are used for the safe and effective treatment of manymedical conditions. Ultrasonic surgical instruments, and particularlysolid core ultrasonic surgical instruments, are advantageous becausethey may be used to cut and/or coagulate tissue using energy in the formof mechanical vibrations transmitted to a surgical end effector atultrasonic frequencies. Ultrasonic vibrations, when transmitted totissue at suitable energy levels and using a suitable end effector, maybe used to cut, dissect, coagulate, elevate or separate tissue.Ultrasonic surgical instruments utilizing solid core technology areparticularly advantageous because of the amount of ultrasonic energythat may be transmitted from the ultrasonic transducer, through anultrasonic transmission waveguide, to the surgical end effector. Suchinstruments may be used for open procedures or minimally invasiveprocedures, such as endoscopic or laparoscopic procedures, wherein theend effector is passed through a trocar to reach the surgical site.

Activating or exciting the end effector (e.g., cutting blade, ballcoagulator) of such instruments at ultrasonic frequencies induceslongitudinal vibratory movement that generates localized heat withinadjacent tissue, facilitating both cutting and coagulating. Because ofthe nature of ultrasonic surgical instruments, a particularultrasonically actuated end effector may be designed to perform numerousfunctions, including, for example, cutting and coagulating.

Ultrasonic vibration is induced in the surgical end effector byelectrically exciting a transducer, for example. The transducer may beconstructed of one or more piezoelectric or magnetostrictive elements inthe instrument hand piece. Vibrations generated by the transducersection are transmitted to the surgical end effector via an ultrasonicwaveguide extending from the transducer section to the surgical endeffector. The waveguides and end effectors are designed to resonate atthe same frequency as the transducer. When an end effector is attachedto a transducer the overall system frequency may be the same frequencyas the transducer itself. The transducer and the end effector may bedesigned to resonate at two different frequencies and when joined orcoupled may resonate at a third frequency. The zero-to-peak amplitude ofthe longitudinal ultrasonic vibration at the tip, d, of the end effectorbehaves as a simple sinusoid at the resonant frequency as given by:

d=A sin(ωt)

where: ω=the radian frequency which equals 2π times the cyclicfrequency, f andA=the zero-to-peak amplitude.The longitudinal excursion is defined as the peak-to-peak (p-t-p)amplitude, which is just twice the amplitude of the sine wave or 2A.

Solid core ultrasonic surgical instruments may be divided into twotypes, single element end effector devices and multiple-element endeffectors. Single element end effector devices include a variety ofblade types such as ball, hooked, curved, and coagulating shears.Single-element end effector instruments have limited ability to applyblade-to-tissue pressure when the tissue is soft and loosely supported.Substantial pressure may be necessary to effectively couple ultrasonicenergy to the tissue. The inability of a single-element end effector tograsp the tissue results in a further inability to fully coapt tissuesurfaces while applying ultrasonic energy, leading to less-than-desiredhemostasis and tissue joining. Multiple-element end effectors include aclamping mechanism comprising a clamp arm that works in conjunction withthe vibrating blade to form a jaw like structure. Ultrasonic clampingcoagulators provide an improved ultrasonic surgical instrument forcutting/coagulating tissue, particularly loose and unsupported tissue.The clamping mechanism presses the tissue against the vibratingultrasonic blade and applies a compressive or biasing force against thetissue to achieve faster cutting and hemostasis (e.g., coagulation) ofthe tissue with less attenuation of blade motion.

As an alternative to open surgical procedures, many modern surgeons useendoscopes and endoscopic instruments to remotely access organs throughsmaller, puncture-like incisions. As a direct result thereof, patientstend to benefit from less scarring and reduced healing time. Endoscopicinstruments are inserted into the patient through a cannula, or port,which has been made with a trocar. Typical sizes for cannulas range fromthree millimeters to twelve millimeters. Smaller cannulas are usuallypreferred. However, the smaller cannulas in turn present additionalchallenges in the design of the endoscopic instruments that fit throughthe smaller cannulas. Many endoscopic surgical procedures requirecutting or ligating blood vessels or vascular tissue as well asgrasping, cutting, dissecting, coagulating, elevating, manipulating,and/or separating tissue.

For the purposes herein, “coagulation” is defined as a process ofdesiccating tissue wherein the tissue cells are ruptured and dried.“Vessel sealing” or “tissue sealing” is defined as the process ofliquefying the collagen in the tissue so that it reforms into a fusedmass. Coagulation of small vessels is sufficient to permanently closethem, while larger vessels need to be sealed to assure permanentclosure. Tissue welding is a technique for closing wounds and vesselsand is applied in many surgical specialties. Tissue welding is atechnique for closing wounds by creating a hemostatic seal in the woundsor vessels as well as creating strong anastomoses in the tissue.Ultrasonic surgical instruments may be employed to achieve hemostasiswith minimal lateral thermal damage to the tissue. The hemostasis oranastomoses occurs through the transfer of mechanical energy to thetissue. Internal cellular friction breaks hydrogen bonds resulting inprotein denaturization. As the proteins are denatured at temperaturesbelow 100° C., a sticky coagulum forms and seals small vessels.Anastomoses occurs when the effects are prolonged. Thus, the ultrasonicenergy in the vibrating blade may be employed to create hemostatic sealsin vessels and adjacent tissues in wounds and to create stronganastomoses in tissue. Ultrasonic vibrating single or multiple endeffectors, either alone or in combination with clamping mechanisms,produce adequate mechanical energy to seal vessels regardless of thetemperature of the end effector and/or the tissue. To create stronganastomoses of the tissue, the temperature of the end effector and thetissue should be maintained below approximately 50° C. to allow for thecreation of a coagulum to seal the tissues together without desiccatingthe tissues.

In the design of medical instruments, several factors may be applied toassess the viability of the ergonomics of a particular design. Onefactor of ergonomics is comfort. Comfort may be characterized by theability to manipulate and control the device without undue musclestrain, pressure points, or other harmful ergonomic effects. Comfort iscreated from properly sized features located to fit the anatomy of theuser, and adequate distribution of force against the user's body. Theability to use an instrument over an extended period without fatigue,pain, or loss of precision is a measure of comfort. Another factor ofergonomics is the ability to use an instrument over an extended timeperiod without fatigue, pain, or loss of precision is a measure ofcomfort. Aside from comfort, one objective factor is the ability tocontrol the working end of the device with the degree of control neededto accomplish the surgical task with ease. The extent that this controlmay be achieved emanates first from the inherent stability of theinstrument in the hand of the user, and second from the ability toperform finer motions in order to manipulate the specific instrumentcontrols. Design efforts balance the ability to achieve overallstability in the hand while facilitating appropriate access and mobilityto utilize the fine controls. The stability of the surgical instrumentin the hand may be accomplished via a variety of grips. Common gripsinclude ring handles, in-line scissors, and pistol configurations, amongothers. Pistol grips generally provide points of fixation on the hand:

(1) A point between the thumb and index finger resting in the web of thejoint;

(2) A grasping force between the thumb and index finger; and

(3) A gripping force between the fingers and the palm when activating atrigger, power switch, knob, lever, or other feature.

Due to the inherent spatial considerations of the surgical cavity,surgeons often have difficulty performing traditional surgical methodsusing endoscopic instruments inserted into the patient through acannula. The spatial limitations, coupled with the multi-functioncapability of many endoscopic instruments, particularly laparoscopicultrasonic surgical instruments, create ergonomic challenges for thesurgeon to easily access and operate the multiple functions and controlsof the instrument. Many ultrasonic surgical instruments withmultiple-element end effectors require a high force of the jaws of theclamping mechanism, which in turn requires higher input forces at thehandle/trigger. This creates challenges in providing a comfortablehandle/trigger interface for the user. Just as important is to enablethe surgeon to finely control the opening motion of the jaws tofacilitate fine dissection without creating fatigue or pressure pointson the surgeon's hands. Activating electrical power switches on theultrasonic instrument housing also presents a challenge. A surgeon needsto easily access any of the switches at any point while also avoidinginadvertent or unintentional activation at any time. Other functionsthat a surgeon may need to perform include rotating the shaft, orselecting power levels. In addition, the user should be able to operateany of these functions without looking, allowing them to focus entirelyon the monitor view during a laparoscopic procedure. In addition, it maybe desirable for the user not to have to reposition their grip in orderto operate any of these key functions the power switches, and be able toeasily manipulate the clamp force or power levels while opening the jawsof the clamping mechanism of the end effector.

Other ergonomic challenges presented by conventional laparoscopicultrasonic surgical instruments include the ability of the user toeasily access and operate multiple functions, sometimes simultaneously.Typically the index finger is used to operate a rotation knob located atthe distal end of the device handle to rotate the shaft. However,controlling the power buttons/switches also employs the use of the indexfinger, creating an inherent challenge for locating the rotation knoband the switches on the housing such that they both may be reached bythe index finger. Ultrasonic devices include multiple controls such asshaft rotation, power settings, and trigger closure that must beaccessible in various hand positions and for many hand sizes.

Traditional laparoscopic ultrasonic surgical instruments usually have arotation control knob located at the distal end of the instrument thatcan be accessed with the index finger to rotate the shaft. However,controlling the power buttons/switches also employs the use of the indexfinger, creating an inherent challenge for locating the rotation knoband the switches on the housing such that they both may be reached bythe index finger. The finger tip rotation control often may be difficultto reach for a surgeon with small hands especially when the instrumentis oriented in positions at extreme angles or orientations that may benecessary to position the tip of the instrument in proximity to theanatomy to be treated.

With respect to hand size, it has long been a challenge to createlaparoscopic ultrasonic surgical instruments with a handle design interms of size, shape, and location of control interfaces that is “ideal”for everyone. The very large disparity of anthropometrics from smallfemales to large males traditionally creates challenges for users at theextreme ends of the spectrum. Although instruments having variousdifferent sized handles to accommodate the disparity in hand sizes havebeen considered, purchasers generally desire to carry fewer inventories,and thus multiple variations have not been accepted. In addition, thereis always the risk that a certain sized handle may not be available to aparticular doctor at a particular hospital.

The multi-function capability of many ultrasonic surgical instruments,particularly laparoscopic ultrasonic surgical instruments, createergonomic challenges in the ability of the user to comfortably accessand operate the multiple functions and controls of the instrument. Thisinclude, for example, the ability to comfortably actuate the jaws of theclamping mechanism and activate the hand control buttons/switches,sometimes simultaneously. The user should be able to control the openingmotion of the end effectors to facilitate spreading dissection.Laparoscopic handle interface designs traditionally incorporate a“scissor” type ring to allow for this outward motion, using outwardmovement of the thumb to oppose the “anchored” fingers. However, thisdoes not provide optimal control of the tip. Some conventionalultrasonic surgical instruments may comprise a pistol grip thatincorporates a trigger that is pushed outward with the index and middlefingers of the user while maintaining a grip on the handle stock,however, this may create fatigue and hand strain. This outward motion,however, may be necessary when doing fine dissection during alaparoscopic procedure. The pistol grip style handle provides comfort,ease, and stability to the surgeon. The conventional pistol grip stylehandle may not be optimum, however, for dissection, where many surgeonsprefer a scissor grip style design instead.

Accordingly, there is a need for an ergonomic handle assembly for anultrasonic surgical instrument that provides the ability of the user tocomfortably access and operate multiple functions. In addition, there isa need for a handle assembly for an ultrasonic surgical instrument thatenables a user to comfortably actuate the jaws of the clamping mechanismand activate the hand control buttons/switches. There is also a need tooptimize the handle assemblies in terms of ergonomic comfort, stability,and controllability for a large range of hand sizes.

SUMMARY

In one embodiment, a surgical instrument comprising a trigger isconfigured to be actuated by a proximally directed force and by adistally directed force. The trigger may comprise a proximal triggerportion having a first length and a distal trigger hook comprising adistal portion having a second length. The second length may be lessthan the first length. The distal trigger hook may be coupled to theproximal trigger portion.

FIGURES

FIG. 1 is a right side view of one embodiment of an ultrasonic surgicalinstrument.

FIG. 2 is a right side view of one embodiment of the ultrasonic surgicalinstrument shown in FIG. 1 without the ultrasonic transducer.

FIG. 3 is a left perspective view of one embodiment of an ultrasonicsurgical instrument showing a housing, a distal rotation assembly, anelongated endoscopic shaft assembly, and an end effector assembly.

FIG. 4 is a left side view of the ultrasonic surgical instrument shownin FIG. 3.

FIG. 5 is a top view of one embodiment of the ultrasonic surgicalinstrument shown in FIG. 3.

FIG. 6 is a bottom view of one embodiment of the ultrasonic surgicalinstrument shown in FIG. 3.

FIG. 7 is a front view of one embodiment of the ultrasonic surgicalinstrument shown in FIG. 3.

FIG. 8 is a rear view of one embodiment of the ultrasonic surgicalinstrument shown in FIG. 3.

FIG. 9 is an enlarged front view of one embodiment of the ultrasonicsurgical instrument shown in FIG. 3.

FIG. 10 is a left perspective view of one embodiment of the end effectorassembly portion of the ultrasonic surgical instrument shown in FIG. 3.

FIG. 11 is a left perspective view of one embodiment of the end effectorassembly portion of the ultrasonic surgical instrument shown in FIG. 3.

FIG. 12 is a right side view of one embodiment of the end effectorassembly portion of the ultrasonic surgical instrument shown in FIG. 3.

FIG. 13 is a left perspective view of one embodiment of the ultrasonicsurgical instrument shown in FIG. 3 showing a central axis “T”.

FIG. 14 is an exploded view of the ultrasonic surgical instrument shownin FIG. 3.

FIG. 15 is a left perspective view of a right half portion of oneembodiment of the handle assembly shown in FIG. 3.

FIG. 16 is a right perspective view of the right half portion of oneembodiment of the handle assembly shown in FIG. 3.

FIG. 17 is a left side view of the right half portion of one embodimentof the handle assembly shown in FIG. 3.

FIG. 18 is a right side view of the right half portion of one embodimentof the handle assembly shown in FIG. 3.

FIG. 19 is a partial cutaway top view of the right half portion of oneembodiment of the handle assembly of the handle assembly shown in FIG.3.

FIG. 20 is a partial cutaway bottom view of the right half portion ofone embodiment of the handle assembly shown in FIG. 3.

FIG. 21 is a partial cutaway front view of the right half portion of oneembodiment of the handle assembly shown in FIG. 3.

FIG. 22 is a partial cutaway bottom view of the right half portion ofone embodiment of the handle assembly shown in FIG. 3.

FIG. 23 is a left perspective view of one embodiment of the ultrasonicsurgical instrument shown in FIG. 3.

FIG. 24 is a cutaway left perspective view of the one embodiment of theultrasonic surgical instrument shown in FIG. 3.

FIG. 25 illustrates relationships between various user interfaces of oneembodiment of the handle assembly shown in FIG. 3.

FIG. 26 illustrates relationships between various user interfaces of oneembodiment of the handle assembly shown in FIG. 3.

FIG. 27 illustrates one embodiment of an ultrasonic surgical instrument.

FIG. 28 is a right side view of one embodiment of an ultrasonic surgicalinstrument comprising a proximal rotation knob.

FIG. 29 is an enlarged right perspective view of one embodiment of theultrasonic surgical instrument shown in FIG. 28

FIG. 30 is a right side view of one embodiment of an ultrasonic surgicalinstrument comprising a proximal rotation assembly.

FIG. 31 is a right side view of one embodiment of the ultrasonicsurgical instrument shown in FIG. 30 with the proximal rotation assemblyand the ultrasonic transducer detached from the housing.

FIG. 32 is a right side view of the proximal rotation assembly shown inFIGS. 30 and 31 detached from the ultrasonic transducer.

FIG. 33 is a left side view of one embodiment of handle assembly for anultrasonic surgical instrument comprising both proximal and distalrotation assemblies.

FIG. 34 is an enlarged partial left perspective view of one embodimentof the handle assembly shown in FIG. 33.

FIG. 35 illustrates a partial cut away view of one embodiment of ahandle assembly for an ultrasonic surgical instrument.

FIG. 36 is an enlarged partial view of one embodiment of the rockerswitch and the reciprocating yoke assembly within the housing of thehandle assembly shown in FIG. 35.

FIG. 37 is a right perspective view of a right housing portion of oneembodiment of a handle assembly for an ultrasonic instrument comprisingboth proximal and distal rotation assemblies with the left housingportion of the housing removed.

FIG. 38 is a left perspective view of the right housing portion of oneembodiment of a handle assembly shown in FIG. 37 with the left housingportion of the housing removed.

FIG. 39 is a left side view of the right housing portion of oneembodiment of the handle assembly shown in FIG. 37 with the left housingportion of the housing removed.

FIG. 40 is a side view of the right housing portion of one embodiment ofthe handle assembly shown in FIG. 37 with the left housing portionremoved.

FIG. 41 is a top view of the right housing portion of one embodiment ofthe handle assembly shown in FIG. 39 taken along line 41-41.

FIG. 42 is a bottom view of the right housing portion of one embodimentof the handle assembly shown in FIG. 39 taken along line 42-42.

FIG. 43 is a front view of the right housing portion of one embodimentof the handle assembly shown in FIG. 41 taken along line 43-43.

FIG. 44 is a rear view of the right housing portion of one embodiment ofthe handle assembly shown in FIG. 41 taken along line 44-44.

FIG. 45 illustrates an exploded view of one embodiment of the proximalrotation assembly shown in FIGS. 37-44.

FIG. 46 is a side view of one embodiment of the proximal rotationassembly shown in FIG. 45.

FIG. 47 is a rear view of one embodiment of the proximal rotation knobshown ion FIG. 46 taken along line 47-47.

FIG. 48 is a front view of one embodiment of the proximal rotation knobshown in FIG. 46 taken along line 48-48.

FIG. 49 is a front view of one embodiment of a cylindrical substrateshown in FIG. 46 taken along line 49-49.

FIG. 50 is a rear view of one embodiment of the cylindrical substrateshown in FIG. 46 taken along line 50-50.

FIG. 51 is a perspective view of one embodiment of the distal rotationassembly shown in FIGS. 37-44.

FIG. 52 is a perspective view of one embodiment of the distal rotationassembly shown in FIG. 51.

FIG. 53 is a first top view of one embodiment of the distal rotationassembly shown in FIG. 51.

FIG. 54 is a second top view of one embodiment of the distal rotationassembly shown in FIG. 53 rotated 45°.

FIG. 55 is a rear view of one embodiment of the distal rotation assemblyshown in FIG. 54 taken along line 55-55.

FIG. 56 is a front view of one embodiment of the distal rotationassembly shown in FIG. 53 taken along line 56-56.

FIG. 57 is a partial right perspective view of one embodiment of thedistal rotation assembly shown in FIGS. 37-44 mechanically engaged tothe distal end of the left housing portion.

FIG. 58 is a right side perspective view of one embodiment of a handleassembly for an ultrasonic surgical instrument suitable to receive ahandle adapter.

FIG. 59 is a right side perspective view of one embodiment of the handleassembly shown in FIG. 58 and one embodiment of a handle adapter.

FIG. 60 is a right side perspective view of one embodiment of the handleassembly shown in FIGS. 58-59 comprising the handle adapter shown inFIG. 59 attached thereto.

FIG. 61 is right perspective view of one embodiment of a handle adaptercomprising snap-button features suitable for attaching to a handleassembly of an ultrasonic surgical instrument.

FIG. 62 is a left perspective view of one embodiment of the handleadapter comprising snap-button features shown in FIG. 61.

FIG. 63 is a left side view of one embodiment of the handle adaptercomprising snap-button features shown in FIG. 62.

FIG. 64 is right side view of one embodiment of the handle adaptercomprising snap-button features shown in FIG. 61.

FIG. 65 is a front view of one embodiment of the handle adaptercomprising snap-button features shown in FIG. 63 taken along lines65-65.

FIG. 66 is a rear view of one embodiment of the handle adaptercomprising snap-button features shown in FIG. 63 taken along lines66-66.

FIG. 67 is a top view of one embodiment of the handle adapter comprisingsnap-button features shown in FIG. 65 taken along lines 67-67.

FIG. 68 is a bottom view of one embodiment of the handle adaptercomprising snap-button features shown in FIG. 66 taken along lines68-68.

FIG. 69 is a rear perspective view of one embodiment of the handleadapter comprising snap-button features shown in FIG. 61.

FIG. 70 illustrates one embodiment of a handle assembly of an ultrasonicsurgical instrument comprising a loop handle adapter assembly.

FIG. 71 is a front perspective view of the loop handle adapter assemblyshown in FIG. 70

FIG. 72 is a rear perspective view of the loop handle adapter assemblyshown in FIG. 71.

FIG. 73 is a left perspective view of the loop handle adapter assemblyshown in FIG. 71.

FIG. 74 is a right perspective view of the loop handle adapter assemblyshown in FIG. 71.

FIG. 75 is a right side view of the loop handle adapter assembly shownin FIG. 71.

FIG. 76 is a left side view of the loop handle adapter assembly shown inFIG. 71.

FIG. 77 is a front view of the loop handle adapter assembly shown inFIG. 75 taken along line 77-77.

FIG. 78 is a rear view of the loop handle adapter assembly shown in FIG.76 taken along line 78-78.

FIG. 79 is a top view of the loop handle adapter assembly shown in FIG.77 taken along line 79-79.

FIG. 80 is a bottom view of the loop handle adapter assembly shown inFIG. 78 taken along line 80-80.

FIG. 81 is a left perspective view of one embodiment of the loop adaptershown in FIGS. 71-80.

FIG. 82 is a front perspective view of one embodiment of the loopadapter shown in FIGS. 71-80.

FIG. 83 is a rear perspective view of one embodiment of a flexibleelement portion of the loop handle assembly shown in FIGS. 71-80.

FIG. 84 is a right side view of one embodiment of the flexible elementshown in FIG. 83.

FIG. 85 is a left side view of one embodiment of the flexible elementshown in FIG. 83.

FIG. 86 is a front view of one embodiment of the flexible element shownin FIG. 84 taken along line 86-86.

FIG. 87 is a rear view of one embodiment of the flexible element shownin FIG. 85 taken along line 87-87.

FIG. 88 illustrates one embodiment of a handle assembly for anultrasonic surgical instrument comprising a curved stability projectionformed at the rear or proximal location of a fixed handle.

FIG. 89 illustrates one embodiment of a handle assembly for anultrasonic surgical instrument comprising protrusions formed on bothsides of a fixed handle.

FIG. 90 illustrates one embodiment of a handle assembly for anultrasonic surgical instrument comprising protrusions formed on bothsides of a fixed handle.

DESCRIPTION

Before explaining the various embodiments in detail, it should be notedthat the embodiments are not limited in its application or use to thedetails of construction and arrangement of parts illustrated in theaccompanying drawings and description. The illustrative embodiments maybe implemented or incorporated in other embodiments, variations andmodifications, and may be practiced or carried out in various ways. Forexample, the surgical instruments, handle assemblies, handle adapters,and other components associated therewith disclosed below areillustrative only and not meant to limit the scope or applicationthereof. Furthermore, unless otherwise indicated, the terms andexpressions employed herein have been chosen for the purpose ofdescribing the illustrative embodiments for the convenience of thereader and are not to limit the scope thereof.

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a clinician gripping a handle portion of thehandle assembly of an ultrasonic surgical instrument. Thus, the endeffector is distal with respect to the more proximal handle portion. Itwill be further appreciated that, for convenience and clarity, spatialterms such as “top” and “bottom” also are used herein with respect tothe clinician gripping the hand portion. However, surgical instrumentsmay be used in many orientations and positions, and these terms are notintended to be limiting and absolute. The term “right” refers to theright side of the instrument from the perspective of a user lookingtoward the “front” of the instrument from the distal end towards theproximal end. The term “left” refers to the left side of the instrumentfrom the perspective of a user looking toward the “front” of theinstrument from the distal end toward the proximal end. The term “rear”refers to the user rear of the instrument from the perspective of theuser looking from the proximal end towards the distal end of theinstrument.

The various embodiments relate, in general, to ultrasonic surgicalinstruments with improved multi-function capabilities and ergonomiccontrol features for use in laparoscopic and/or traditional opensurgical procedures. The ergonomic features described with respect tothe various embodiments of the ultrasonic surgical instruments enhancethe ability of the user to easily and comfortably access and operatemultiple functions of the instruments located in multiple places on theinstruments, in order to maximize the level of precision and control thesurgeon has when performing a clinical task.

Various embodiments of ultrasonic surgical instruments described hereincomprise comfortable and ergonomic control features associated with thehandle and trigger interfaces for the user. This may alleviate stressesand fatigue in applications that require very high clamping forcesbetween the jaws of the end effector. The ergonomic features provideease of control of the opening motion of the jaws to facilitate varioussurgical procedures, such as fine dissection. Electrical power switchesare provided to activate an ultrasonic transducer assembly. Theseswitches may be hand operated such that the user may easily access oneor more of the power switches at any point while avoiding inadvertent orunintentional activation at any time. The switches include features thatenable to user to select the proper switch without looking. Similarly,rotational control of the shaft is easily accessed. This allows the userto focus entirely on the monitor view during a laparoscopic procedure,for example. The switches may be activated without the userrepositioning the grip on the instrument. The user can easily controlpower application while simultaneously opening the jaws of the endeffector. In one embodiment, the power switches may be implemented as aMIN/MAX rocker-style or “toggle” style switch. In a forward position,the MIN/MAX toggle switch provides an easily accessible contact surfaceprojection for power activation without repositioning of the hand grip,making it suitable to maintain control and keep attention focused on thesurgical site (e.g., a monitor in a laparoscopic procedure).

There has been a long sought need to provide surgical instrument handlesin terms of size, shape, and location of control interfaces thatsuitably accommodate the large disparity of anthropometrics from smallfemales to large males and of various ethnicities. Users at theseextreme ends of the spectrum traditionally have difficulty usingconventionally sized instrument handles as intended. Thus, variousembodiments provide a handle assembly for a surgical instrument thatsuitably accommodates a substantially larger range of hand sizes.Various embodiments provide more optimally designed ergonomic featuresfor comfortably controlling the surgical instrument during use. Variousembodiments provide multiple ergonomic hand adaptors are provided.

Certain embodiments will now be described to provide an overallunderstanding of the principles of the structure, function, manufacture,and use of the devices and methods disclosed herein. One or moreexamples of these embodiments are illustrated in theaccompanying-drawings. Those of ordinary skill in the art willunderstand that the devices and methods specifically described hereinand illustrated in the accompanying drawings are non-limitingembodiments and that the scope of the various embodiments is definedsolely by the claims. The features illustrated or described inconnection with one embodiment may be combined with the features ofother embodiments. Such modifications and variations are intended to beincluded within the scope of the claims.

FIGS. 1-25 illustrate one embodiment of an ultrasonic surgicalinstrument suitable for endoscopic or traditional open surgicalprocedures. In the embodiment illustrated in FIGS. 1-25, a surgicalinstrument comprises improved multi-functional capabilities andergonomic features for use in laparoscopic and/or traditional opensurgical procedures. The ergonomic features of the surgical instrumentenhance the ability of the user to easily access and operate themultiple functions and controls of the surgical instrument. Theergonomic features of the multi-functional ultrasonic surgicalinstrument enable the user to easily access and operate the multiplefunctions and controls of the instrument.

In one embodiment, the instrument comprises a handle assembly comprisinga rotation knob located at a distal end of the handle assembly. The usermay use a finger to operate the distal rotation knob. The rotation knobis mechanically engaged to an ultrasonic transmission waveguide shaft,which is coupled to the clamping mechanism of the end effector assembly.Thus, the user may employ a finger to rotate the distal rotation knob tosuitably orient the jaws of the clamping mechanism of the end effectorassembly.

In one embodiment, the handle assembly comprises a rocker switch tocontrol the power for energizing the ultrasonic transducer. In oneembodiment, the rocker switch pivots between a maximum (MAX) powersetting and a minimum (MIN) power setting. The MIN/MAX rocker switch issuitably located on a fixed handle portion of the handle assembly sothat the rocker switch may be operated with the same finger thatoperates the distal rotation knob. However, a button switch may locatedon a moving part of the instrument, such as the trigger. Accordingly,the same finger can be used both for rotation of the shaft and operationof the power activation. The rocker switch may comprise identifyingtactile features.

In one embodiment, a pivotably moveable trigger comprising a hookfeature may be employed to actuate the jaws or clamping mechanism of theend effector assembly. A series of linkages translate the pivotalrotation of the trigger to axial movement of a yoke coupled to anactuation mechanism, which controls the opening and closing of the jawsof the clamping mechanism of the end effector assembly located at thedistal end of the ultrasonic surgical instrument. In one embodiment,multiple links may be employed to provide mechanical advantage in arelatively short pivotal rotation span. The trigger may be operated by afinger other than the finger used to control the distal rotation knob orthe toggle switch. The trigger activation finger(s) also may be employedto engage the hook feature to restore the jaws of the clamping mechanismof the end effector assembly to a predetermined state.

In one embodiment, a rotation knob may be located at a proximal end ofthe ultrasonic surgical instrument. The proximal rotation knob may beeasily accessed with the thumb or finger and substantially reduces anyobstructions or “reaching” that may be associated with a distallylocated rotation knob.

In one embodiment, rotation knobs may be located at distal and proximalends of the ultrasonic surgical instrument. The distal and proximalrotation knobs may be easily accessed with either the thumb or fingersfor convenience. Furthermore, the opposing nature of the thumb andfinger actions used alternately substantially reduces winding of theelectrical cord supplying power to the ultrasonic transducer. Thenatural tendency of the user is to rotate in only a downward directionbecause it is easier to push down than to push upward. With rotationknobs both distal and proximal, the a right-handed user uses theproximal knob to push down to rotate to the left, and uses the distalknob to push down to rotate to the right, thereby reducing oreliminating the “cord wind” of rotating only in one direction. Thedistal and proximal rotation knobs may be operated in conjunction witheach other or may be rotated independently.

In various embodiments, multiple adapters may be provided to accommodatedifferent sized hands. Adapters may comprise on open proximal end andcan be removably attached to a fixed handle of a handle assembly eitherfrictionally or by snap buttons. Adapters may comprise a closed proximalend to form a loop for receiving a thumb therethrough. Variousembodiments of the loop adapter comprise a pliable polymeric element foradded comfort.

In one embodiment, a handle assembly may comprise a projection formed ona fixed handle portion of the handle assembly. In another embodiment,the hand assembly may comprise protrusions formed on either side of thefixed handle of the hand assembly. These projections and protrusionsreduce or minimize fatigue and increase control when using certainultrasonic surgical instruments while operating the instrument.

FIG. 1 is a right side view of one embodiment of an ultrasonic surgicalinstrument 100. In the illustrated embodiment, the ultrasonic surgicalinstrument 100 may be employed in various surgical procedures includingendoscopic or traditional open surgical procedures. In one embodiment,the ultrasonic surgical instrument 100 comprises a handle assembly 102,an elongated endoscopic shaft assembly 110, and an ultrasonic transducer114. The handle assembly 102 comprises a trigger assembly 104, a distalrotation assembly 106, and a switch assembly 108. The elongatedendoscopic shaft assembly 110 comprises an end effector assembly 112,which comprises elements to dissect tissue or mutually grasp, cut, andcoagulate vessels and/or tissue, and actuating elements to actuate theend effector assembly 112. The handle assembly 102 is adapted to receivethe ultrasonic transducer 114 at the proximal end. The ultrasonictransducer 114 is mechanically engaged to the elongated endoscopic shaftassembly 110 and portions of the end effector assembly 112. Theultrasonic transducer 114 is electrically coupled to a generator 116 viaa cable 118. Although the majority of the figure drawings depict amultiple end effector assembly 112 for use in connection with endoscopicsurgical procedures, the ultrasonic surgical instrument 100 may beemployed in more traditional open surgical procedures. For the purposesherein, the ultrasonic surgical instrument 100 is described in terms ofan endoscopic instrument; however, it is contemplated that an openversion of the ultrasonic surgical instrument 100 also may include thesame or similar operating components and features as described herein.

FIG. 2 is a right side view of one embodiment of the ultrasonic surgicalinstrument 100 shown in FIG. 1 without the ultrasonic transducer 114. Inthe illustrated embodiment, the trigger assembly 104 comprises a trigger120 that works in conjunction with a fixed handle 122. The fixed handle122 and the trigger 120 are ergonomically formed and adapted tointerface comfortably with the user. The fixed handle 122 is integrallyassociated with the handle assembly 102. The trigger 120 is pivotallymovable relative to the fixed handle 122 as explained in more detailbelow with respect to the operation of the ultrasonic surgicalinstrument 100. The trigger 120 is pivotally movable in direction 121Atoward the fixed handle 122 when the user applies a squeezing forceagainst the trigger 120. A spring element 182 (FIG. 14) causes thetrigger 120 to pivotally move in direction 121B when the user releasesthe squeezing force against the trigger 120.

In one embodiment, the trigger 120 comprises an elongated trigger hook124, which defines an aperture 126 between the elongated trigger hook124 and the trigger 120. The aperture 126 is suitably sized to receiveone or multiple fingers of the user therethrough. The trigger 120 alsomay comprise a resilient portion 120 a molded over the trigger 120substrate. The overmolded resilient portion 120 a is formed to provide amore comfortable contact surface for control of the trigger 120 inoutward direction 121B. In one embodiment, the overmolded resilientportion 120 a may be provided over a portion of the elongated triggerhook 124. For example, in the illustrated embodiment, the overmoldedresilient portion 120 a is provided over the distal and top surfaces ofthe inner portion of the elongated trigger hook 120 to cushion thecontact surface between the finger and the elongated trigger hook 124.The proximal surface of the elongated trigger hook 120 remains uncoatedor coated with a non-resilient substrate to enable the user to easilyslide their fingers in and out of the aperture 126. In otherembodiments, the elongated trigger hook 124 may incorporate anovermolded component formed of pliable, resilient, flexible polymericmaterials including Versaflex® TPE alloys made by GLS Corporation, forexample. The overmolded resilient portion 120 a of the elongated triggerhook 124 may provide added comfort or form a more secure grip for theuser. The overmolded resilient portion 120 a on the top portion of theinterior portion of the elongated trigger hook 124 may be contoured toalleviate edge pressure points against the fingers as they enter theaperture 126. In another embodiment, the geometry of the trigger forms afully closed loop which defines an aperture suitably sized to receiveone or multiple fingers of the user therethrough. The fully closed looptrigger also may comprise a resilient portion molded over the triggersubstrate. The overmolded resilient portion is formed to provide a morecomfortable contact surface for control of the trigger in outwarddirection.

In one embodiment, the fixed handle 122 comprises a proximal contactsurface 128 and a grip anchor or saddle surface 130. The saddle surface130 rests on the web where the thumb and the index finger are joined onthe hand. The proximal contact surface 128 has a pistol grip contourthat receives the palm of the hand in a normal pistol grip with no ringsor apertures. The profile curve of the proximal contact surface 128 maybe contoured to accommodate or receive the palm of the hand. To providecomfort and control while using the ultrasonic instrument 100, theprofile of the proximal contact surface 128 is optimized to fit thenatural anatomical contours in the valley of the center of the palm andbase of the thumb. The saddle surface 130 provides a primary point ofstability of the grip, which is the basis of the stability of control ofthe handle assembly 102. The saddle surface 130 is the reference pointthat determines a range of motion of the fingers and thumb relative tothe proximal contact surface 128 of the fixed handle 122, the elongatedtrigger hook 124, the distal rotation assembly 106, and the toggleswitch 132. A stabilization tail 131 is located towards a more proximalportion of the handle assembly 102. The stabilization tail 131 may be incontact with the uppermost web portion of the hand located between thethumb and the index finger to stabilize the handle assembly 102 and makethe handle assembly 102 more controllable. The stabilization tail 131provides an area extending in the proximal direction to allow theproximal weight of the ultrasonic surgical instrument 100 to bedistributed to the top of the hand without restriction motion. Theconfiguration of the saddle surface 130 and the stabilization tail 131provides a greater sense of stability, comfort, and control for the userwhile manipulating the handle assembly 102.

In one embodiment, the switch assembly 108 may comprise a toggle switch132. The toggle switch 132 may be implemented as a single component witha central pivot 304 (FIG. 34) located within inside the handle assembly102 to eliminate the possibility of simultaneous activation. In oneembodiment, the toggle switch 132 comprises a first projecting knob 132a and a second projecting knob 132 b to set the power setting of theultrasonic transducer 114 between a minimum power level (e.g., MIN) anda maximum power level (e.g., MAX). The toggle switch 132 rotates aboutthe central pivot 304 as the first projecting knob 132 a and the secondprojecting knob 132 b are actuated. The one or more projecting knobs 132a, b are coupled to one or more arms that move through a small arc andcause electrical contacts (e.g., electrical elements 172 b as shown inFIG. 36) to close or open an electric circuit to electrically energizeor de-energize the ultrasonic transducer 114 in accordance with theactivation of the first or second projecting knobs 132 a,b. The toggleswitch 132 is coupled to the generator 116 to control the activation ofthe ultrasonic transducer 114. The toggle switch 132 comprises one ormore electrical power setting switches to activate the ultrasonictransducer 114 to set one or more power settings for the ultrasonictransducer 114. The forces required to activate the toggle switch 132are directed substantially toward the saddle point 130, thus avoidingany tendency of the instrument to rotate in the hand when the toggleswitch 132 is activated.

In one embodiment, the first and second projecting knobs 132 a,b arelocated on the distal end of the handle assembly 102 such that they canbe easily accessible by the user to activate the power with minimal, orsubstantially no, repositioning of the hand grip, making it suitable tomaintain control and keep attention focused on the surgical site (e.g.,a monitor in a laparoscopic procedure) while activating the toggleswitch 132. The projecting knobs 132 a,b may be configured to wraparound the side of the handle assembly 102 to some extent to be moreeasily accessible by variable finger lengths and to allow greaterfreedom of access to activation in awkward positions or for shorterfingers.

In one embodiment, the first and second projecting knobs 132 a,b may beovermolded with pliable, resilient, flexible polymeric materialsincluding Versaflex® TPE alloys made by GLS Corporation, for example.The overmolded material may be selected to withstand sterilization andto be biocompatible. Furthermore, the material may be selected to give aproper level of resilience and to provide adequate frictional resistanceto surgical gloves. The overmolded portion may comprise projections withidentifying tactile features useful for tactile identification ordifferentiation of the projecting knobs 132 a,b or the rest of thehandle assembly 102. As previously discussed, one of the projectingknobs 132 a,b may comprises a texture or tactile surface that enablesthe user to differentiate between the first projecting knob 132 a andthe second projecting knob 132 b. In the illustrated embodiment, thefirst projecting knob 132 a comprises a plurality of tactile elements132 c, e.g., textured projections or “bumps” in the illustratedembodiment, to allow the user to differentiate the first projecting knob132 a (MAX) from the second projecting knob 132 b (MIN).

In one embodiment, the toggle switch 132 may be operated by the hand ofthe user. The user may easily access the first and second projectingknobs 132 a,b at any point while also avoiding inadvertent orunintentional activation at any time. The toggle switch 132 may readilyoperated with a finger to control the power to the ultrasonic assembly114 and/or to the ultrasonic assembly 114. For example, the index fingermay be employed to activate the first contact portion 132 a to turn onthe ultrasonic assembly 114 to a maximum (MAX) power level. The indexfinger may be employed to activate the second contact portion 132 b toturn on the ultrasonic assembly 114 to a minimum (MIN) power level. Thetoggle switch 132 may be operated without the user having to look at thefirst or second projecting knob 132 a,b. This allows the user to focusentirely on the monitor view during a laparoscopic procedure.Accordingly, the first projecting knob 132 a or the second projectingknob 132 b may comprise a texture or projections to tactilelydifferentiate between the first and second projecting knobs 132 a,bwithout looking For example, in the illustrated embodiment, the firstprojecting knob 132 a comprises a plurality of tactile elements 132 c toallow the user to tactilely differentiate between the first projectingknob 132 a (MAX) and the second projecting knob 132 b (MIN). Othertactile textures or elements may be formed on either of the first orsecond projecting knobs 132 a,b to for purposes of differentiationtherebetween. The user does not have to reposition their grip in orderto operate the toggle switch 132 and can easily control power levelswhile opening the jaws of the end effector 112.

In one embodiment, the distal rotation assembly 106 is rotatable withoutlimitation in either direction about a longitudinal axis “T” (FIG. 13).The distal rotation assembly 106 is mechanically engaged to theelongated endoscopic shaft assembly 110. The distal rotation assembly106 is located on a distal end of the handle assembly 102. The distalrotation assembly 106 comprises a cylindrical hub 133 and a rotationknob 134 formed over the hub 133. The hub 133 mechanically engages theelongated endoscopic shaft assembly 110. The rotation knob 134 maycomprise fluted polymeric features and may be engaged by a finger (e.g.,an index finger) to rotate the elongated endoscopic shaft assembly 110.The hub 133 may comprise a material molded over the primary structure toform the rotation knob 134. The rotation knob 134 may be overmolded overthe hub 133. The hub 133 comprises an end cap portion 133 a that isexposed at the distal end. The end cap portion 133 a of the hub 133 maycontact the surface of a trocar during laparoscopic procedures. The hub133 may be formed of a hard durable plastic such as polycarbonate toalleviate any friction that may occur between the end cap portion 133 aand the trocar. The rotation knob 134 may comprise “scallops” or flutesformed of raised ribs 134 a and concave portions 134 b located betweenthe ribs 134 a to provide a more precise rotational grip. In oneembodiment, the rotation knob 134 may comprise a plurality of flutes(e.g., three or more flutes). In other embodiments, any suitable numberof flutes may be employed. The rotation knob 134 may be formed of asofter polymeric material overmolded onto the hard plastic material. Forexample, the rotation knob 134 may be formed of pliable, resilient,flexible polymeric materials including Versaflex® TPE alloys made by GLSCorporation, for example. This softer overmolded material may provide agreater grip and more precise control of the movement of the rotationknob 134. It will be appreciated that any materials that provideadequate resistance to sterilization, are biocompatible, and provideadequate frictional resistance to surgical gloves may be employed toform the rotation knob 134.

In one embodiment, the handle assembly 102 may comprise and may beconfigured with ergonomic features to enable the user to easily accessand operate the multiple functions and controls of the ultrasonicsurgical instrument 100. Accordingly, a finger may be used to operatethe distal rotation knob 134 located at the distal portion of the handleassembly 102. The rotation knob 134 is coupled to the elongatedendoscopic shaft assembly 110 of the ultrasonic transmission waveguideshaft by the hub 133. Thus, the finger can be used to rotate theultrasonic transmission waveguide elongated endoscopic shaft assembly110 by rotating the rotation knob 134. The MIN/MAX power buttons of thetoggle switch 132 are suitably located on a distal end of the handleassembly 122 of the instrument 100 so that they may be operated with theindex finger, for example. Accordingly, the index finger may be used torotate the shaft of the elongated endoscopic shaft assembly 110 toorient the jaws of the clamping mechanism of the end effector assembly112 in a desired position and to activate the ultrasonic transducer 114to a suitable power level.

FIG. 3 is a left perspective view of one embodiment of the ultrasonicsurgical instrument 100 showing the handle assembly 102, the distalrotation assembly 106, the elongated endoscopic shaft assembly 110, andthe end effector assembly 112. With reference to FIGS. 3-9, in theillustrated embodiment the elongated endoscopic shaft assembly 110comprises a distal end 138 dimensioned to mechanically engage the endeffector assembly 112 and a proximal end 136 that mechanically engagesthe handle assembly 102 and the distal rotation assembly 106. Theproximal end 136 of the elongated endoscopic shaft assembly 110 isreceived within the handle assembly 102 and the distal rotation assembly106. More details relating to the connections between the elongatedendoscopic shaft assembly 110, the handle assembly 102, and the distalrotation assembly 106 are provided in the description of FIGS. 14 and24.

In one embodiment, the handle assembly 102 is formed from two (2)housing portions or shrouds comprising a first portion 102 a and asecond portion 102 b. From the perspective of a user viewing the handleassembly 102 from the distal end towards the proximal end, the firstportion 102 a is considered the right portion and the second portion 102b is considered the left portion. Each of the first and second portions102 a,b includes a plurality of interfaces 158 (FIG. 14) dimensioned tomechanically align and engage each another to form the handle assembly102 and enclosing the internal working components thereof. The fixedhandle 122, which is integrally associated with the handle assembly 102,takes shape upon the assembly of the first and second portions 102 a and102 b of the handle assembly 102. A plurality of additional interfaces(not shown) may be disposed at various points around the periphery ofthe first and second portions 102 a and 102 b of the handle assembly 102for ultrasonic welding purposes, e.g., energy direction/deflectionpoints. The first and second portions 102 a and 102 b (as well as theother components described below) may be assembled together in anyfashion known in the art. For example, alignment pins, snap-likeinterfaces, tongue and groove interfaces, locking tabs, adhesive ports,may all be utilized either alone or in combination for assemblypurposes.

In one embodiment, the elongated endoscopic shaft assembly 110 comprisesa proximal end 136 adapted to mechanically engage the handle assembly102 and the distal rotation assembly 106; and a distal end 138 adaptedto mechanically engage the end effector assembly 112. The elongatedendoscopic shaft assembly 110 comprises an outer tubular sheath 142 anda reciprocating tubular actuating member 144 located within the outertubular sheath 142. The proximal end of the tubular reciprocatingtubular actuating member 144 is mechanically engaged to the trigger 120of the handle assembly 102 to move in either direction 146A or 146B inresponse to the actuation and/or release of the trigger 120. Thepivotably moveable trigger 120 may be employed to actuate the jaws orclamping mechanism of the end effector assembly 112. A series oflinkages translate the pivotal rotation of the trigger 120 to axialmovement of a yoke coupled to an actuation mechanism, which controls theopening and closing of the jaws of the clamping mechanism of the endeffector assembly 112. The distal end of the tubular reciprocatingtubular actuating member 144 is mechanically engaged to the end effectorassembly 112. In the illustrated embodiment, the distal end of thetubular reciprocating tubular actuating member 144 is mechanicallyengaged to a clamp arm assembly 150, which is pivotable about a pivotpoint 154, to open and close the clamp arm assembly 150 in response tothe actuation and/or release of the trigger 120. For example, in theillustrated embodiment, the clamp arm assembly 150 is movable indirection 148A from an open position to a closed position about a pivotpoint 154 when the trigger 120 is squeezed in direction 121A. The clamparm assembly 150 is movable in direction 148B from a closed position toan open position about the pivot point 154 when the trigger 120 isreleased or outwardly contacted in direction 121B.

In one embodiment, the end effector assembly 112 is attached at thedistal end 138 of the elongated endoscopic shaft assembly 110 andincludes a clamp arm assembly 150 and a blade 152. The jaws of theclamping mechanism of the end effector assembly 112 are formed by clamparm assembly 150 and the blade 152. The blade 152 is ultrasonicallyactuatable and is acoustically coupled to the ultrasonic transducer 114.The trigger 120 on the handle assembly 102 is ultimately connected to adrive assembly, which together, mechanically cooperate to effectmovement of the clamp arm assembly 150. Squeezing the trigger 120 indirection 121A moves the clamp arm assembly 150 in direction 148A froman open position, wherein the clamp arm assembly 150 and the blade 152are disposed in a spaced relation relative to one another, to a clampedor closed position, wherein the clamp arm assembly 150 and the blade 152cooperate to grasp tissue therebetween. The clamp arm assembly 150 maycomprise a clamp pad 158 to engage tissue between the blade 152 and theclamp arm 150. Releasing the trigger 120 in direction 121B moves theclamp arm assembly 150 in direction 148B from a closed relationship, toan open position, wherein the clamp arm assembly 150 and the blade 152are disposed in a spaced relation relative to one another.

The proximal portion of the handle assembly 102 comprises a proximalopening 156 to receive the distal end of the ultrasonic assembly 114.The ultrasonic assembly 114 is inserted in the proximal opening 156 andis mechanically engaged to the elongated endoscopic shaft assembly 110.

In one embodiment, the elongated trigger hook 124 portion of the trigger120 provides a longer trigger lever with a shorter span and rotationtravel. The longer lever of the elongated trigger hook 124 allows theuser to employ multiple fingers within the aperture 126 to operate theelongated trigger hook 124 and cause the trigger 120 to pivot indirection 121B to open the jaws of the end effector assembly 112. Forexample, the user may insert three fingers (e.g., the middle, ring, andlittle fingers) in the aperture 126. Multiple fingers allows the surgeonto exert higher input forces on the trigger 120 and the elongatedtrigger hook 124 to activate the end effector assembly 112. The shorterspan and rotation travel creates a more comfortable grip when closing orsqueezing the trigger 120 in direction 121A or when opening the trigger120 in the outward opening motion in direction 121B lessening the needto extend the fingers further outward. This substantially lessens handfatigue and strain associated with the outward opening motion of thetrigger 120 in direction 121B. The outward opening motion of the triggermay be spring-assisted by spring element 182 (FIG. 14) to help alleviatefatigue. The opening spring force is sufficient to assist the ease ofopening, but not strong enough to adversely impact the tactile feedbackof tissue tension during spreading dissection.

For example, during a surgical procedure either the index finger may beused to control the rotation of the elongated endoscopic shaft assembly110 to locate the jaws of the end effector assembly 112 in a suitableorientation. The middle and/or the other lower fingers may be used tosqueeze the trigger 120 and grasp tissue within the jaws. Once the jawsare located in the desired position and the jaws are clamped against thetissue, the index finger can be used to activate the toggle switch 132to adjust the power level of the ultrasonic transducer 114 to treat thetissue. Once the tissue has been treated, the user the may release thetrigger 120 by pushing outwardly in the distal direction against theelongated trigger hook 124 with the middle and/or lower fingers to openthe jaws of the end effector assembly 112. This basic procedure may beperformed without the user having to adjust their grip of the handleassembly 102.

FIGS. 10-12 illustrate the connection of the elongated endoscopic shaftassembly 110 relative to the end effector assembly 112. As previouslydescribed, in the illustrated embodiment, the end effector assembly 112comprises a clamp arm assembly 150 and a blade 152 to form the jaws ofthe clamping mechanism. The blade 152 may be an ultrasonicallyactuatable blade acoustically coupled to the ultrasonic transducer 114.The trigger 120 is mechanically connected to a drive assembly. Together,the trigger 120 and the drive assembly mechanically cooperate to movethe clamp arm assembly 150 to an open position in direction 148B whereinthe clamp arm assembly 150 and the blade 152 are disposed in spacedrelation relative to one another, to a clamped or closed position indirection 148A wherein the clamp arm assembly 150 and the blade 152cooperate to grasp tissue therebetween. The clamp arm assembly 150 maycomprise a clamp pad 158 to engage tissue between the blade 152 and theclamp arm 150. The distal end of the tubular reciprocating tubularactuating member 144 is mechanically engaged to the end effectorassembly 112. In the illustrated embodiment, the distal end of thetubular reciprocating tubular actuating member 144 is mechanicallyengaged to the clamp arm assembly 150, which is pivotable about thepivot point 154, to open and close the clamp arm assembly 150 inresponse to the actuation and/or release of the trigger 120. Forexample, in the illustrated embodiment, the clamp arm assembly 150 ismovable from an open position to a closed position in direction 148Aabout a pivot point 154 when the trigger 120 is squeezed in direction121A. The clamp arm assembly 150 is movable from a closed position to anopen position in direction 148B about the pivot point 154 when thetrigger 120 is released or outwardly contacted in direction 121B.

FIG. 13 is a left perspective view of one embodiment of the ultrasonicsurgical instrument shown in FIG. 3 showing a central longitudinal axis“T”.

FIG. 14 is an exploded view of the ultrasonic surgical instrument 100shown in FIG. 3. In the illustrated embodiment, the exploded view showsthe internal elements of the handle assembly 102, the handle assembly102, the distal rotation assembly 106, the switch assembly 108, and theelongated endoscopic shaft assembly 110. With reference now to FIGS.14-24, in the illustrated embodiment, the first and second portions 102a,b mate to form the handle assembly 102. The first and second portions102 a,b each comprises a plurality of interfaces 158 dimensioned tomechanically align and engage one another to form the handle assembly102 and enclose the internal working components of the ultrasonicsurgical instrument 100. The rotation knob 134 is mechanically engagedto the outer tubular sheath 142 so that it may be rotated in circulardirection 140 up to 360°. The outer tubular sheath 142 is located overthe reciprocating tubular actuating member 144, which is mechanicallyengaged to and retained within the handle assembly 102 via a pluralityof coupling elements 160. The coupling elements 160 may comprise anO-ring 160 a, a tube collar cap 160 b, a distal washer 160 c, a proximalwasher 160 d, and a thread tube collar 160 e. The reciprocating tubularactuating member 144 is located within a reciprocating yoke 170, whichis retained between the first and second portions 102 a,b of the handleassembly 102. The yoke 170 is part of a reciprocating yoke assembly 173.A series of linkages translate the pivotal rotation of the elongatedtrigger hook 120 to the axial movement of the reciprocating yoke 170,which controls the opening and closing of the jaws of the clampingmechanism of the end effector assembly 112 at the distal end of theultrasonic surgical instrument 100. In one embodiment, a four-linkdesign provides mechanical advantage in a relatively short rotationspan, for example.

In one embodiment, an ultrasonic transmission waveguide 164 is disposedinside the reciprocating tubular actuating member 144. The distal end138 of the ultrasonic transmission waveguide 164 is acoustically coupledto the blade 152 and the proximal end 136 of the ultrasonic transmissionwaveguide 164 is received within the handle assembly 102. The proximalend 136 of the ultrasonic transmission waveguide 164 is adapted toacoustically couple to the distal end of the ultrasonic transducer 114as discussed in more detail below. The ultrasonic transmission waveguide164 is isolated from the other elements of the elongated endoscopicshaft assembly 110 by a protective sheath 166 and a plurality ofisolation elements 168, such as silicone rings. The outer tubular sheath142, the reciprocating tubular actuating member 144, and the ultrasonictransmission waveguide 164 are mechanically engaged by a pin 162. Theswitch assembly 108 comprises the toggle switch 132 and electricalelements 172 a,b to electrically energize the ultrasonic transducer 114in accordance with the activation of the first or second projectingknobs 132 a,b.

In one embodiment, the outer tubular sheath 142 isolates the user or thepatient from the ultrasonic vibrations of the ultrasonic transmissionwaveguide 164. The outer tubular sheath 142 generally includes a hub163. The outer tubular sheath 142 is threaded onto the distal end of thehandle assembly 102. The ultrasonic transmission waveguide 164 extendsthrough the opening of the outer tubular sheath 142 and the isolationelements 168 isolate the ultrasonic transmission waveguide 104 from theouter tubular sheath 142. The outer tubular sheath 142 may be attachedto the waveguide 164 with the pin 162. The hole to receive the pin 162in the waveguide 164 may occur nominally at a displacement node. Thewaveguide 164 may screw or snap into the hand piece handle assembly 102by a stud 226 (FIG. 27). Flat portions on the hub 163 may allow theassembly to be torqued to a required level.

In one embodiment, the hub 163 portion of the outer tubular sheath 142is preferably constructed from plastic and the tubular elongated portionof the outer tubular sheath 142 is fabricated from stainless steel.Alternatively, the ultrasonic transmission waveguide 164 may comprisepolymeric material surrounding it to isolate it from outside contact.

In one embodiment, the distal end of the ultrasonic transmissionwaveguide 164 may be coupled to the proximal end of the blade 152 by aninternal threaded connection, preferably at or near an antinode. It iscontemplated that the blade 152 may be attached to the ultrasonictransmission waveguide 164 by any suitable means, such as a welded jointor the like. Although the blade 152 may be detachable from theultrasonic transmission waveguide 164, it is also contemplated that thesingle element end effector (e.g., the blade 152) and the ultrasonictransmission waveguide 164 may be formed as a single unitary piece.

In one embodiment, the trigger 120 is coupled to a linkage mechanism totranslate the rotational motion of the trigger 120 in directions 121Aand 121B to the linear motion of the reciprocating tubular actuatingmember 144 in corresponding directions 146A and 146B. The trigger 120comprises a first set of flanges 182 with openings formed therein toreceive a first yoke pin 176 a. The first yoke pin 176 a is also locatedthrough a set of openings formed at the distal end of the yoke 170. Thetrigger 120 also comprises a second set of flanges 180 to receive afirst end 176 a of a link 176. A trigger pin 174 is received in openingsformed in the link 176 and the second set of flanges 180. The triggerpin 174 is received in the openings formed in the link 176 and thesecond set of flanges 180 and is adapted to couple to the first andsecond portions 102 a,b of the handle assembly 102 to form a triggerpivot point 190 (FIGS. 25, 26) for the trigger 120. A second end 176 bof the link 176 is received in a slot 184 formed in a proximal end ofthe yoke 170 and is retained therein by a second yoke pin 178 b. As thetrigger 120 is pivotally rotated about the pivot point 190 formed by thetrigger pin 174, the yoke translates horizontally along longitudinalaxis “T” in a direction indicated by arrows 146A,B.

FIGS. 25 and 26 illustrate relationships between various user interfacesof one embodiment of the handle assembly 102. In the illustratedembodiment, the user may employ a control finger to activate the powerbuttons of the toggle switch 132 and to control the rotation of therotation knob 134 and precisely control the rotation of the end effectorassembly 112. The control finger may be the index finger; however, theembodiments are not limited in this context. As illustrated, a controlfinger location 186 a is used to operate (e.g., rotate) the distalrotation knob 134. The distance between the control finger location 186a and the saddle surface 130 is “d1”. In one embodiment, for example, d1may be approximately 3.17 inches. Without changing the grip relative tothe fixed handle 122 the user also may operate the first projecting knob132 a by locating a finger in control finger location 186 b to set thepower to a first level (e.g., MAX) and may operate the second projectingknob 132 b by locating the finger at control finger location 186 c toset the power to a second level (e.g., MIN). The distance between thecontrol finger location 186 b and the saddle surface 130 is “d2” and thedistance between the control finger location 186 c and the saddlesurface 130 is “d3”. In one embodiment, for example, d2 may beapproximately 2.55 inches and d3 may be approximately 2.46 inches.Accordingly, the user may easily and readily locate the control fingerat three control finger locations 186 a, 186 b, and 186 c withoutre-gripping the handle assembly 102 to operate the respective distalrotation knob 134, the first projecting knob 132 a, and the secondprojecting knob 132 b. Each of the rotation and power controls arereadily accessible with the control finger without being too crowdedtogether and resulting in a balanced access of all three.

In one embodiment, a trigger finger of the user may be located in afirst position 188 a within the aperture 126 to operate the trigger 120.The distance between the first position 188 a and the saddle surface 130is “d4”. In one embodiment for example, d4 may be approximately 2.11inches. The trigger finger may be the middle finger. As illustrated, thetrigger finger may be contacted with the molded resilient portion 120 aof the trigger 120. As the trigger 120 is squeezed in direction 121A, itpivots about the pivot point 190 from a fully open to a fully closedposition, shown in phantom in FIG. 26. As the trigger 120 pivots aboutthe pivot point 190 from a fully open position to a fully closedposition, the trigger finger location moves from the trigger fingerlocation 188 a to the trigger finger location 188 b, shown in phantom.

The spread angles φ₁-φ₃ are defined as the angles formed between thetrigger finger location 188 a with the trigger 120 in a fully openposition and a control finger located on a control element. A firstangle φ₁ is defined as the angle formed between the trigger fingerlocation 188 a and the control finger location 186 a in contact with thedistal rotation knob 134. In one embodiment, for example, φ₁ may beapproximately forty-six degrees. A second angle φ₂ is defined as theangle formed between the trigger finger location 188 a and the controlfinger location 186 b in contact with the first projecting knob 132 a.In one embodiment, for example, φ₂ may be approximately thirty-threedegrees. A third angle φ₃ is defined as the angle formed between thetrigger finger location 188 a and the control finger location 186 c incontact with the second projecting knob 132 b. In one embodiment, angleφ₃ may be approximately twenty degrees and the angle φ₄ between thecontrol finger location 188 a and the axis S may be approximatelynineteen degrees. The access spread is a combination of the distance “d”between the saddle surface 130 and the control finger location 186 a,186 b, or 186 c and the spread angle φ between the control fingerlocation and the trigger finger location. The distances d₁, d₂, and d₃and the spread angles φ₁, φ₂, and φ₃ are optimized for ergonomicpurposes. For example, the spread angles may be selected such that:

φ₃<φ₂<φ₁; and

d₃<d₂<d₁.

The spread angle φ₁ represents the spread between the control fingerlocation 186 a on the distal rotation knob 134 and the trigger fingerlocation 188 a. The access spread 192 a between the control fingerposition 186 a and the trigger finger position 188 a is the largest ofthe three access spreads 192 a, 192 b, and 192 c. Operation of thedistal rotation knob 134 requires the most finger spread of all theother controls. Further, the distal rotation knob 134 requires adifferent force vector (e.g., downward) to actuate than the firstprojecting knob 132 a or the second projecting knob 132 b, whichrequires less strain on the finger. The distal rotation knob 134 can beconfigured to deactivate and lock-out when the trigger 120 is in thefully closed position, shown in phantom, which also alleviates the“worst case” finger spread angle φ₁. In general, the spacing 196 betweenthe distal rotation knob 134 and the first projecting knob 132 a may beselected to minimize crowding therebetween and to minimize difficulty ofaccess for larger fingers.

The spread angle φ₂ represents the spread between the control fingerlocation 186 b at the first projecting knob 132 a and the trigger fingerlocation 188 a. The access spread 192 b between the control fingerlocation 186 b and the trigger finger location 188 a is slightly greaterthan the access spread 192 c between the control finger location 186 cand the trigger finger location 188 a and requires more finger spread toaccess the first projecting knob 132 a than the second projecting knob132 b. The first projecting knob 132 a is located sufficiently apartfrom the second projecting knob 132 b to minimize any perceived risk ofinadvertent activation. In addition, the first projecting knob 132 a isspaced sufficiently apart from the distal rotation knob 134 to minimizecrowding and any difficulty of access for larger fingers. The spacing196 between the distal rotation knob 134 and the first projecting knob132 a may be selected such that it is minimized to keep the distalrotation knob 134 within reach of the control finger location 186 a andis maximized to avoid crowding between the distal rotation knob 134 andthe first projecting knob 132 a.

The spread angle φ₃ represents the spread between the control fingerlocation 186 c at the second projecting knob 132 b and the triggerfinger location 188 a. The access spread 192 c between the controlfinger location 186 c and the trigger finger position 188 a is the leastspread required between the middle and control fingers and accordinglyresults in the lowest finger strain. Access to the second projectingknob 132 b requires the least finger spread of all the controls andtherefore tends to be the easiest to activate. In the fully openposition, the second projecting knob 132 b is located as low as possiblewithout being too crowded against the trigger 120 and thus avoiding“crossing” the trigger finger. The spacing 194 between the secondprojecting knob 132 b and the trigger 120 a may be selected to minimizethe finger spread angle required to reach the first projecting knob 132a when the trigger 120 is in the fully closed position, shown inphantom, and the trigger finger is at position 188 b, also shown inphantom.

In one embodiment, the location of the trigger pivot 190 may be selectedto control and optimize the arc of motion of the trigger 120 as itpivots from a fully open position, shown in solid line, to a fullyclosed position, shown in phantom, especially as it relates to therelative trigger finger location at each end of the span. The idealmotion arc is slightly upward moving from closed to open, to relate tothe natural opening motion of the fingers. The fully closed positionslightly increases the angle of the finger spread required to accesscontrols, but is acceptable in balance to the natural motion arc of thetrigger 120. When the trigger 120 is in the fully closed position, thetrigger finger location 188 b slightly increases the angle of the fingerspread angle φ required to access the various controls (i.e., the angleφ formed between the middle and the control fingers). The increase,however, is minimized to be within an acceptable balance to the naturalmotion arc of the trigger 120.

FIG. 26 illustrates relationships between various user interfaces of oneembodiment of the handle assembly 102. In the illustrated embodiment,the handle assembly 102 may be defined as having four separate axis. Alongitudinal axis “T” that coincides with the longitudinal axis of theelongated endoscopic shaft assembly 110, a saddle surface axis “S”, auser input axis “U”, a base axis “L”, the trigger 120 pivot point 190, acenter point 191 of the elongated trigger hook 124, the saddle surface130, the control finger locations 186 a, 186 b, 186 c, and the triggerfinger locations 188 a, 188 b. The trigger hook 124 defines an arcuateportion defined by radius “r₁” and center point 191. The handle assembly102 provides suitable spacing between the trigger 120 and the fixedhandle 122 at full closure. The spacing/contouring of the secondprojecting knob 132 b (e.g., MIN button) and the top of the elongatedtrigger hook 124 pushes out the trigger finger when opening the trigger120 while activating the second projecting knob 132 b.

In one embodiment, the activation user input force “f₁” is the forcenecessary to activate the first projecting knob 132 a or the secondprojecting knob 132 b. In one embodiment, the force f₁ is approximately400 g+/−80 g. The activation user input force f₁ is a balance betweenminimizing user fatigue (not too hard) and minimizing risk ofinadvertent activation (not too light). The activation user input forcef₁ is measured along the A-E vector (the vector from the saddle surface130 to the finger location 186 b) to activate the first projecting knob132 a and the A-F vector (the vector from the saddle surface 130 to thefinger location 186 c) to activate the second projecting knob 132 b.

In one embodiment, a control (e.g., index) finger “rest area” 193 isdefined as the space between the first projecting knob 132 a and thesecond projecting knob 132 b (e.g., MIN/MAX button spacing). A user canapply up to approximately 1.5 lbf of force on the rest area 193 betweenthe first projecting knob 132 a and the second projecting knob 132 bwith the control finger without activating power.

In one embodiment, the first projecting knob 132 a and the secondprojecting knob 132 b may be activated with a directional pressurevector from 0° to 30° to either side relative to the medial center planeof the hand assembly 102. This provides greater access to the firstprojecting knob 132 a and the second projecting knob 132 b when thewrist is in an extreme position with shorter fingers.

In one embodiment, the center line between the second projecting knob132 b and the highest finger located within the aperture 126 defined bythe elongated trigger hook 124 is approximately at least 0.650″ tomaximize comfort and minimize a feeling of “crossing” two adjacentfingers.

In one embodiment, the finger clearance within the aperture 126 of theelongated trigger hook 124 is approximately at least 0.650″ to avoidfinger entrapment.

In one embodiment, the user input axis (U) is defined as the axis Udirectly between the middle and ring finger positions on the trigger120. The trigger 120 closing force applied by the user is defined as theforce f₂ measured along the U-X vector (the vector from the proximalcontact surface 128 to the first position 188 a within the aperture126). In one embodiment, the force required to close the trigger 120 toa fully closed position, as measured along U-X vector, may beapproximately less than 6.14 lbs, based upon the following:

140.8 lbs=maximum full-hand grip force for 5% small female;

-   -   40.8 lbs×0.33=13.64 lbs (67% reduction for comfortable grip        force);    -   13.64 lbs×0.60=8.18 lbs (40% reduction for poor posture); and    -   8.18 lbs×0.75=6.14 lbs (25% reduction for removing index from        the full grip: relative finger strengths: Index: 25%, Middle:        35%, Ring: 25%, little: 14%, source: NCBI Pub Med, 07/04).

In one embodiment, a trigger 120 abuse closing force is defined as theclosing force generated when the trigger is closed by applying pressureon the distal surface of the elongated trigger hook 124. In oneembodiment, the reasonable abuse force that the trigger 120 canwithstand is approximately 15.00 lbs, based upon that the high end ofthe actual closing force manufacturing variation is 5 lbs. and it wouldbe rare to expect that the user will exert more that three-times therequired force.

In one embodiment, the trigger 120 opening force is defined as the forcef₃ required by the user to fully open trigger 120, as measured along theU-X vector. In one embodiment, the force f₃ is approximately0.0+0.5/−1.5 lbf. In one embodiment, the handle assembly 102incorporates some means of spring-assisted opening to overcome thefriction in the system such as spring element 182 (FIG. 14). In oneembodiment, the jaws of the end effector assembly 112 should becomefully open on their own with minimal force required. The “automatic”full opening suitably enhances ease of use when applying multipleclosure “bites” in succession. Minimizing the force required for thejaws of the end effector assembly 112 to open reduces risk of losingtactile feedback during spreading dissection (surgeons want to feel thetissue tension being applied as much as possible, not the spring), forexample.

In one embodiment, the contact surface width of the trigger 120 may beapproximately 0.760″+/−0.200″ as measured at the user input axis “U” toprovide maximum comfort and avoid pressure points.

In one embodiment, the length of the elongated trigger hook 124 asmeasured from the elongated trigger hook center 191 to the end of theforward hook loop may be approximately 1.090″+/−0.080″ to facilitatetwo-finger contact for an outward opening stroke of the trigger 120.

In one embodiment, the length of the trigger 120 as measured from theelongated trigger hook center 191 to the lowermost end of the trigger120 should be approximately 2.480″+/−0.080″ to facilitate three-fingercontact for closing stroke.

In one embodiment, the longitudinal center of gravity may be locatedapproximately 0.700″+/−0.150″ proximal to the origin of the elongatedendoscopic shaft assembly 110 at point as defined by the location of theinsulated pin. The total weight of the device defined as the handleassembly fully assembled the cable 118 cut off at a proximal terminationof strain relief. In one embodiment, the center of gravity may be keptcloser to the center of the palm of the user for maximum feeling ofcontrol and stability.

In one embodiment, the palm surface length of the fixed handle 122 maybe approximately 2.900″+/−0.125″ as measured vertically from A-L (fromthe saddle surface 130 to the base of the fixed handle 122). Thisdistance may be determined by balancing maximizing size for larger handcomfort and stability and minimizing potential interference of thehandle assembly 102 with a patient (usually happens if legs are raised)or table.

In one embodiment, the palm surface width does not exceed approximately1.320″. This distance may be determined by balancing comfort against thepalm of the user when closing pressure is applied to the trigger 120,access around the back surface area of the fixed handle 122 to the frontcontrols for smaller hands, and overall “fit” in the hand of the user.The side surfaces of the fixed handle 122 may be curved and contoured tonaturally fit the palm of a hand and provide stability for the thumb andindex finger grip locations.

In one embodiment, the fully closed grip span as measured from U-X′ maybe greater than approximately 1.600″. The fully open grip span asmeasured from U-X may be less than a maximum of approximately 2.300″.

In one embodiment, the distal rotation knob 134 user interface maycomprise a multi-flute design, with a finger-contact radius ofapproximately 0.250″+/−0.050″ for each flute 134 a. In one embodiment,the flutes 134 a may be overmolded to increase gripping ability on thedistal rotation knob 134.

In one embodiment, the rotation force is defined as the frictional forceof the distal rotation knob 134 when it is connected to the handleassembly 112. The rotation force should provide a torque resistance ofapproximately 3.5-12.5 in-oz. This value may be determined by balancingsuitable resistance at the low end to overcome reversal of the shaft dueto winding of the cord and minimizing user input force at the high endto minimize fatigue.

In one embodiment, the overmolding compliance of the molded resilientportion 120 a of the trigger 120 surface may be less than approximately0.040″ at any point of contact in the loaded trigger motion to maximizetactile feedback. This value may be determined by balancing providingincreased user comfort during repetitive trigger actuation (especiallyoutward finger extension) and not losing tactile feedback of forcesbeing applied to tissue.

In one embodiment, the overall configuration of the handle assembly 102may be based upon a pistol-grip design, with an optimal palm proximalcontact surface 128 (P) as described and illustrated in the embodimentsherein. In one embodiment, the optimization of the proximal contactsurface 128 may comprise a contact surface that is best defined by anorganic curve that naturally fits the palm of the hand, rather than aspecified angle of the grip. This ideal curve provides maximum gripcomfort, control, and stability. Locating the saddle surface 130directly below the location of the stabilization tail 131 provides addedfeeling of control and stability in the nook or web defined between thethumb and index finger.

As can also be seen in FIG. 26, the contact surface 128 may have aradius RH that is measured from reference point RP. Reference point RPmay be located a first distance HD1 from axis S and a second distanceHD2 from point A. In one embodiment, for example, radius RH may beapproximately 2.99 inches, distance HD1 may be approximately 2.27 inchesand distance HD2 may be approximately 2.20 inches. Also in variousembodiments, the stabilization tail 131 may have a first radius portionRT of approximately 0.40 inches and a second radius RT2 measured from asecond reference point RP2 that may be approximately 2.91 inches. Thesecond reference point RP2 may be located a distance TL from point A,wherein TL may be approximately 1.31 inches and a distance TL2 from axisS which may be approximately 2.33 inches.

In one embodiment, the edges of the handle assembly 102 contacting thepalm or fingers of the user have a minimum radius of approximately0.040″, unless the material has a durometer of 70 A or less.

FIG. 27 illustrates one embodiment of an ultrasonic surgical instrument100. In the illustrated embodiment, a cross-sectional view of theultrasonic transducer 114 is shown within a partial cutaway view of thehandle assembly 102. One embodiment of the ultrasonic surgicalinstrument 100 comprises the ultrasonic signal generator 116 coupled tothe ultrasonic transducer 114, comprising a hand piece housing 198, andan ultrasonically actuatable single or multiple element end effectorassembly 112. As previously discussed, the end effector assembly 112comprises the ultrasonically actuatable blade 152 and the clamp arm 150.The ultrasonic transducer 114, which is known as a “Langevin stack”,generally includes a transduction portion 200, a first resonator portionor end-bell 202, and a second resonator portion or fore-bell 204, andancillary components. The total construction of these components is aresonator. The ultrasonic transducer 114 is preferably an integralnumber of one-half system wavelengths (nλ/2; where “n” is any positiveinteger; e.g., n=1, 2, 3 . . . ) in length as will be described in moredetail later. An acoustic assembly 206 includes the ultrasonictransducer 114, a nose cone 208, a velocity transformer 218, and asurface 210.

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a clinician gripping the handle assembly 102 ofthe handle assembly 102. Thus, the end effector assembly 112 is distalwith respect to the more proximal handle assembly 102 of the handleassembly 102. It will be further appreciated that, for convenience andclarity, spatial terms such as “top” and “bottom” also are used hereinwith respect to the clinician gripping the handle assembly 102. However,surgical instruments are used in many orientations and positions, andthese terms are not intended to be limiting and absolute.

In one embodiment, the distal end of the end-bell 202 is connected tothe proximal end of the transduction portion 200, and the proximal endof the fore-bell 204 is connected to the distal end of the transductionportion 200. The fore-bell 204 and the end-bell 202 have a lengthdetermined by a number of variables, including the thickness of thetransduction portion 200, the density and modulus of elasticity of thematerial used to manufacture the end-bell 202 and the fore-bell 22, andthe resonant frequency of the ultrasonic transducer 114. The fore-bell204 may be tapered inwardly from its proximal end to its distal end toamplify the ultrasonic vibration amplitude as the velocity transformer218, or alternately may have no amplification. A suitable vibrationalfrequency range may be about 20 Hz to 120 kHz and a well-suitedvibrational frequency range may be about 30-100 kHz. A suitableoperational vibrational frequency may be approximately 55.5 kHz, forexample.

In one embodiment, the piezoelectric elements 212 may be fabricated fromany suitable material, such as, for example, lead zirconate-titanate,lead meta-niobate, lead titanate, barium titanate, or otherpiezoelectric ceramic material. Each of positive electrodes 214,negative electrodes 216, and the piezoelectric elements 212 has a boreextending through the center. The positive and negative electrodes 214and 216 are electrically coupled to wires 220 and 222, respectively. Thewires 220 and 222 are encased within the cable 118 and electricallyconnectable to the ultrasonic signal generator 116.

The ultrasonic transducer 114 of the acoustic assembly 206 converts theelectrical signal from the ultrasonic signal generator 116 intomechanical energy that results in primarily a standing acoustic wave oflongitudinal vibratory motion of the ultrasonic transducer 114 and theblade 152 portion of the end effector assembly 112 at ultrasonicfrequencies. In another embodiment, the vibratory motion of theultrasonic transducer may act in a different direction. For example, thevibratory motion may comprise a local longitudinal component of a morecomplicated motion of the tip of the elongated endoscopic shaft assembly110. A suitable generator is available as model number GEN04, fromEthicon Endo-Surgery, Inc., Cincinnati, Ohio. When the acoustic assembly206 is energized, a vibratory motion standing wave is generated throughthe acoustic assembly 206. The ultrasonic surgical instrument 100 isdesigned to operate at a resonance such that an acoustic standing wavepattern of predetermined amplitude is produced. The amplitude of thevibratory motion at any point along the acoustic assembly 206 dependsupon the location along the acoustic assembly 206 at which the vibratorymotion is measured. A minimum or zero crossing in the vibratory motionstanding wave is generally referred to as a node (i.e., where motion isminimal), and a local absolute value maximum or peak in the standingwave is generally referred to as an anti-node (i.e., where local motionis maximal). The distance between an anti-node and its nearest node isone-quarter wavelength (λ/4).

The wires 220 and 222 transmit an electrical signal from the ultrasonicsignal generator 116 to the positive electrodes 214 and the negativeelectrodes 216. The piezoelectric elements 212 are energized by theelectrical signal supplied from the ultrasonic signal generator 116 inresponse to an actuator 224, such as a foot switch, for example, toproduce an acoustic standing wave in the acoustic assembly 206. Theelectrical signal causes disturbances in the piezoelectric elements 212in the form of repeated small displacements resulting in largealternating compression and tension forces within the material. Therepeated small displacements cause the piezoelectric elements 212 toexpand and contract in a continuous manner along the axis of the voltagegradient, producing longitudinal waves of ultrasonic energy. Theultrasonic energy is transmitted through the acoustic assembly 206 tothe blade 152 portion of the end effector assembly 112 via atransmission component or an ultrasonic transmission waveguide portion164 of the elongated endoscopic shaft assembly 110.

In one embodiment, in order for the acoustic assembly 206 to deliverenergy to the blade 152 portion of the end effector assembly 112, allcomponents of the acoustic assembly 206 must be acoustically coupled tothe blade 152. The distal end of the ultrasonic transducer 114 may beacoustically coupled at the surface 210 to the proximal end of theultrasonic transmission waveguide 164 by a threaded connection such as astud 226.

In one embodiment, the components of the acoustic assembly 206 arepreferably acoustically tuned such that the length of any assembly is anintegral number of one-half wavelengths (nλ/2), where the wavelength λis the wavelength of a pre-selected or operating longitudinal vibrationdrive frequency f_(d) of the acoustic assembly 206. It is alsocontemplated that the acoustic assembly 206 may incorporate any suitablearrangement of acoustic elements.

In one embodiment, the blade 152 may have a length substantially equalto an integral multiple of one-half system wavelengths (nλ/2). A distalend of the blade 152 may be disposed near an antinode in order toprovide the maximum longitudinal excursion of the distal end. When thetransducer assembly is energized, the distal end of the blade 152 may beconfigured to move in the range of, for example, approximately 10 to 500microns peak-to-peak, and preferably in the range of about 30 to 150microns at a predetermined vibrational frequency of 55 kHz, for example.

In one embodiment, the blade 152 may be coupled to the ultrasonictransmission waveguide 164. The blade 152 and the ultrasonictransmission waveguide 164 as illustrated are formed as a single unitconstruction from a material suitable for transmission of ultrasonicenergy. Examples of such materials include Ti6Al4V (an alloy of Titaniumincluding Aluminum and Vanadium), Aluminum, Stainless Steel, or othersuitable materials. Alternately, the blade 152 may be separable (and ofdiffering composition) from the ultrasonic transmission waveguide 164,and coupled by, for example, a stud, weld, glue, quick connect, or othersuitable known methods. The length of the ultrasonic transmissionwaveguide 164 may be substantially equal to an integral number ofone-half wavelengths (nλ/2), for example. The ultrasonic transmissionwaveguide 164 may be preferably fabricated from a solid core shaftconstructed out of material suitable to propagate ultrasonic energyefficiently, such as the titanium alloy discussed above (i.e., Ti6Al4V)or any suitable aluminum alloy, or other alloys, for example.

In one embodiment, the ultrasonic transmission waveguide 164 comprises alongitudinally projecting attachment post at a proximal end to couple tothe surface 210 of the ultrasonic transmission waveguide 164 by athreaded connection such as the stud 226. The ultrasonic transmissionwaveguide 164 may include a plurality of stabilizing silicone rings orcompliant supports 168 (FIG. 14) positioned at a plurality of nodes. Thesilicone rings 168 dampen undesirable vibration and isolate theultrasonic energy from an outer protective sheath 166 (FIG. 14) assuringthe flow of ultrasonic energy in a longitudinal direction to the distalend of the blade 152 with maximum efficiency.

In various embodiments a rotation knob may be located in a proximal endof the ultrasonic surgical instrument housing. The proximal rotationknob may be accessed easily with the thumb or index finger andsubstantially reduces any obstructions or “reach” issues that may beassociated with a distally located rotation know. Several embodiments ofultrasonic surgical instruments comprising a proximal rotation knob aredescribed with reference to FIGS. 28-32.

FIG. 28 is a right side view of one embodiment of an ultrasonic surgicalinstrument 230 comprising a proximal rotation knob 238. In theillustrated embodiment, the proximal rotation knob 238 may be located ata proximal end of the handle assembly 102. The proximal rotation knob238 may be accessed easily with the thumb or index finger andsubstantially reduces any obstructions or “reach” issues that may beassociated with a distally located rotation knob. The ultrasonicsurgical instrument 230 may be employed in various surgical proceduresincluding endoscopic or traditional open surgical procedures. Theultrasonic surgical instrument 230 comprises the handle assembly 102, ahandle assembly 232, a proximal rotation assembly 234, a switch assembly236, the elongated endoscopic shaft assembly 110, and the end effectorassembly 112 comprising elements to mutually grasp, cut, and coagulatetubular vessels and/or tissue. The proximal rotation assembly 234comprises a proximal rotation knob 238 that mechanically engages theultrasonic transducer 114 housing. The ultrasonic surgical instrument230 is adapted to receive an ultrasonic transducer 114 that ismechanically engaged to the elongated endoscopic shaft assembly 110 andportions of the end effector assembly 112. The ultrasonic transducer 114is electrically coupled to a generator 116 via a cable 118. Although themajority of the figure drawings depict a multiple end effector assembly112 for use in connection with endoscopic surgical procedures, theultrasonic apparatus may be employed in more traditional open surgicalprocedures. For purposes herein, the ultrasonic surgical instrument 100is described in terms of an endoscopic instrument; however, it iscontemplated that an open version of the ultrasonic surgical instrument230 also may include the same or similar operating components andfeatures as described herein.

In one embodiment, the handle assembly 232 comprises a trigger 246 andthe fixed handle 122 previously described. The fixed handle 122 isintegrally associated with the handle assembly 102 and the trigger 246is movable relative to the fixed handle 122 as explained in more detailbelow with respect to the operation of the ultrasonic surgicalinstrument 230. The fixed handle 122 and the trigger 246 comfortablyinterface with the user. The trigger 246 moves in direction 121A towardthe fixed handle 122 when the user applies a squeezing force against thetrigger 246. A spring element 182 (FIG. 14) causes the trigger 246 tomove in direction 121B when the user releases the squeezing forceagainst the trigger 246. The trigger 246 comprises an elongated triggerhook 244, which defines an aperture 248 between the elongated triggerhook 244 and the fixed handle 122. The aperture 248 is suitably sized toreceive one or multiple fingers of the user therethrough. The trigger246 also may comprise a contact portion (not shown), which may be moldedover portions of the trigger 246. The overmolded contact portionprovides a more comfortable contact surface for outward control of thetrigger 246 in direction 121B. In one embodiment, the overmolded contactportion may be provided over a portion of the elongated trigger hook244. For example, the overmolded contact portion may be provided overthe distal and top surfaces of the inner portion of the elongatedtrigger hook 244 to provide cushion where it is needed by the user. Theproximal surface of the elongated trigger hook 244 is not coated andremains bare substrate (e.g., polycarbonate) to enable the fingers toslide in and out of the aperture 248 more easily. In other embodiments,the elongated trigger hook 244 may incorporate overmolded contactsurfaces comprising pliable, resilient, flexible polymeric materialssuch as polyurea elastomers made by VersaFlex, Inc., for example. Theelongated trigger hook 244 may incorporate the overmolded contactsurface portion to provide added comfort or a more secure grip to theuser. The overmolded contact surface portion on the top portion of theinterior portion of the elongated trigger hook 244 alleviates an edgepressure point on the user's finger as it enters the aperture 248. Thefixed handle 122 comprises proximal contact surface 128 and a gripanchor or saddle surface 130 as previously discussed with reference toFIGS. 1-25.

In use, the proximal rotation knob 238 allows users to rotate theelongated endoscopic shaft assembly 110, control the jaws of theclamping mechanism of the end effector assembly 112, and activate therocker switches 132 simultaneously, which creates new uses for thedevice for experienced users.

FIG. 29 is an enlarged right perspective view of one embodiment of theultrasonic surgical instrument 230 shown in FIG. 28. In illustratedembodiment, the proximal rotation assembly 234 comprises a rotation knob238 or ring formed of pliable, resilient, flexible polymeric materialsincluding Versaflex® TPE alloys made by GLS Corporation, for example. Inone embodiment, the proximal rotation knob 238 may be located on aproximal portion of the handle assembly 102. The user may operate theproximal rotation knob 238 with either the thumb or the index finger.Using the thumb frees up the index finger to more easily and effectivelyaccess the toggle switch 252 located on the distal end of the handleassembly 102. The proximal rotation knob 238 may be constructed inmultiple elements. One element may comprise a siliconized polycarbonatecomponent overmolded with a resilient layer formed of elastomericmaterials, thermoplastic rubber known as Santoprene®, otherthermoplastic vulcanizates (TPVs), or elastomers, for example. Theelastomeric layer provides a secure grip for the user on the outer edgeof the proximal rotation knob 238, and also protrudes through an innerpolycarbonate ring (not shown) to form “gripper” ribs that firmly gripthe exterior housing of the ultrasonic transducer 114. Therefore, theproximal rotation knob 238 securely grips the ultrasonic transducer 114.The ultrasonic transducer 114 is securely mechanically engaged to theelongated endoscopic shaft assembly 110, such that the entire elongatedendoscopic shaft assembly 110 can be rotated when the proximal knob 238is rotated. The proximal rotation assembly 234 comprising the proximalrotation knob 238 provides a smoother, easier rotation for bettercontrol and ease of use. The proximal rotation knob 238 stabilizes theinterior mechanism located in front of the ultrasonic transducer 114 toreduce any potential “rattles.” The proximal rotation knob 238 isconfigured to mechanically engage the housing of the ultrasonictransducer 114 such that rotation of the proximal rotation knob 238results in rotation of the ultrasonic transducer 114 and the elongatedendoscopic shaft assembly 110 in the same direction 250. The proximalrotation knob 238 comprises a plurality of flutes 240 or ribs. Theseflutes 240 may be engaged by a finger to rotate the rotation knob 238.The proximal rotation knob 238 may comprise “scallops” or flutes formedof flutes 240 to provide a more precise rotational grip. In oneembodiment, the proximal rotation knob 238 may comprise six flutes. Inother embodiments, any suitable number of flutes may be employed. Theproximal rotation knob 238 may be formed of a softer polymeric materialovermolded onto the hard plastic material.

The ultrasonic transducer 114 may be inserted through the proximalrotation knob 238 until the distal end of the ultrasonic transducer 114screws in or is snapped onto the ultrasonic transmission waveguide 164by the stud 226 (FIG. 27), for example. The elastomeric gripper ribs ofthe proximal rotation knob 238 provide a snug fit during insertionbetween the elastomeric gripper ribs and the outer diameter of theultrasonic transducer 114. The gripper grip, however, is not tightenough to create difficulty in assembling the components. When theultrasonic transducer 114 is threaded into the female portion of thehandle 102 within the proximal opening 156, the proximal rotation knob238 is free to rotate along with the ultrasonic transducer 114 and alsois free to slide longitudinally along the longitudinal axis A along theouter surface of the ultrasonic transducer 114 as the final threads pullthe ultrasonic transducer 114 forward into the elongated endoscopicshaft assembly 110. After the ultrasonic transducer 114 is completelyassembled with a torque wrench, the proximal rotation knob 238 remainsfree to spin, gripping the ultrasonic transducer 114 and therebyrotating the entire elongated endoscopic shaft assembly 110. The gripperribs secure the outer surface of the ultrasonic transducer 114 enough tofacilitate rotation even under surgical conditions in which the assemblyor the user's gloves may be wet, for example.

In one embodiment, the switch assembly 236 may be implemented as aMIN/MAX rocker-style or “toggle” switch 252. In one position, theMIN/MAX rocker-style switch (or “toggle” style) buttons create an easilyaccessible location for power activation with minimal (or almost no)repositioning of the hand grip, making it suitable to maintain controland keep attention focused on the surgical site (e.g., a monitor in alaparoscopic procedure). The switch assembly 236 comprises a toggleswitch 252 partially located within the handle assembly 102. The switchassembly 236 comprises a rocker switch 252 implemented as a singlecomponent with a central pivot located inside the handle assembly 102,to eliminate the possibility of simultaneous activation. The rockerswitch 252 may wrap around the side of the fixed handle 122 slightly tobe easily accessible by variable finger lengths. The toggle switch 252is coupled to the generator 116 to control the activation of theultrasonic transducer 114. The toggle switch 252 comprises one or moreelectrical power setting switches to activate the ultrasonic transducer114 to set one or more power settings for the ultrasonic transducer 114.In one embodiment, the toggle switch 252 comprises a first electricalcontact portion 252 a and a second electrical contact portion 252 b toset the power setting of the ultrasonic transducer 114 between a minimumpower level (e.g., MIN) and maximum power level (e.g., MAX). The firstand second contact portions 252 a,b of the toggle switch 252 may beovermolded with a soft polymeric material including Versaflex® TPEalloys made by GLS Corporation, for example. The overmolding portion maybe useful for tactile identification or differentiation of the toggleswitch 252 contact portions 252 a,b from the rest of the handle assembly102. The contact portions 252 a,b may be configured to wrap around thefixed handle 122 to some extent to allow greater freedom of access toactivation in awkward positions or for shorter fingers. As previouslydiscussed, on of the contact portions 252 a,b may comprise a texture ortactile surface that enables the user to differentiate between the firstcontact portion 252 a and the second contact portion 252 b. Either thefirst contact portion 252 a or the second contact portion 252 b maycomprise a plurality of textured ribs 252 c to allow the user todifferentiate the first contact portion 252 a (MAX) from the secondcontact portion 252 b (MIN).

The toggle switch 252 may be operated by the hand of the user. The usermay easily access the first and second electrical contact portions 252a,b at any point while also avoiding inadvertent or unintentionalactivation at any time. The toggle switch 252 may be operated by theindex finger of the user to activate power to the ultrasonic assembly114 and/or control the power level of the ultrasonic assembly 114. Theindex finger may be employed to activate the first contact portion 252 ato turn on the ultrasonic assembly 114 to a maximum (MAX) power level.The index finger may be employed to activate the second contact portion252 b to turn on the ultrasonic assembly 114 to a minimum (MIN) powerlevel. The first contact portion 252 a or the second contact portion 252b may comprise a texture to assist the user to differentiate betweenthem using tactile feel without looking For example, in the illustratedembodiment, the first contact portion 252 a comprises a plurality oftextured ribs 252 c to enable the user to differentiate the firstcontact portion 252 a (MAX) from the second contact portion 252 b (MIN).Other textures or elements may be formed on either of the first orsecond contact portions 252 a,b to enable the user to differentiatetherebetween. The toggle switch 252 may be operated without the userhaving to look at the first or second contact portions 252 a,b. Thisallows the user to focus entirely on the monitor view during alaparoscopic procedure. The user does not have to reposition their gripin order to operate the toggle switch 252 and can easily adjust thepower ON/OFF or MIN/MAX while opening the jaws of the end effectorassembly 112.

In one embodiment, the proximal rotation assembly 234 is rotatablewithout limitation in either direction 250 about a longitudinal axis “T”(FIG. 13). The proximal rotation assembly 234 is mechanically engaged tothe housing of the ultrasonic transducer 114, which is mechanicallyengaged to the elongated endoscopic shaft assembly 110. The proximalrotation assembly 234 is located at a proximal portion of the handleassembly 102. The proximal rotation assembly 234 comprises internalprotrusions to mechanically engage the housing of the ultrasonictransducer 114, which is mechanically engaged to the elongatedendoscopic shaft assembly 110. The rotation knob 238 may be engaged bythe index finger to rotate the elongated endoscopic shaft assembly 110360° in direction 250.

In one embodiment, the ultrasonic surgical instrument 230 may beconfigured with ergonomic features to enable the user to easily accessand operate the multiple functions and controls of the instrument.Accordingly, the index finger may be used to operate the distal rotationknob 238 located at the proximal end of the handle assembly 102. Therotation knob 238 is mechanically engaged to the hosing of theultrasonic transducer 114, which is mechanically engaged andacoustically coupled to the ultrasonic transmission waveguide 164 (FIG.14). Thus, the index finer can be used to rotate the rotation knob 238to rotate shaft of the ultrasonic transmission waveguide 164 to locatethe end effector assembly 112 in the proper orientation during asurgical procedure. The MIN/MAX power buttons of the rocker switch 252are suitably located on the fixed handle 122 of the instrument 230 sothat they may be operated with the index finger. Accordingly, the indexfinger can be used to rotate the shaft of the endoscopic portion 110 toorient the jaws of the end effector assembly 112 in a desired positionand to activate the power level of the ultrasonic transducer 114.

FIGS. 30-32 illustrate one embodiment of an ultrasonic surgicalinstrument 260 comprising a proximal rotation assembly 262. In theillustrated embodiment, the ultrasonic surgical instrument 260comprising the proximal rotation assembly 262 may be employed in varioussurgical procedures including endoscopic or traditional open surgicalprocedures. In one embodiment, the ultrasonic surgical instrument 260may be configured with ergonomic features to enable the user to easilyaccess and operate the multiple functions and controls of theinstrument. The proximal rotation assembly 262 may be located on aproximal end of the handle assembly 102 and may be accessed easily withthe thumb or finger (e.g., the index finger). This substantially reducesany obstructions or “reach” issues that may be associated with arotation knob located at the distal end of the handle assembly 102. Inaddition, use of the thumb frees up the index finger, for example, tomore easily and effectively access the toggle switch 132 located at thedistal end of the handle assembly 102.

In one embodiment, the proximal rotation assembly 262 comprises a ringshaped proximal rotation knob 264. The proximal rotation knob 264 isconfigured to mechanically or frictionally engage the outer surface 115of the ultrasonic transducer 114. As previously discussed, theultrasonic transducer 114 is mechanically engaged to the elongatedendoscopic shaft assembly 110. Thus, rotating the rotation knob 264rotates the ultrasonic transducer 114 and the elongated endoscopic shaftassembly 110 in the same direction 250. The proximal rotation knob 264comprises a plurality of flutes 266 (e.g., ribs or scallops) formed onan exterior portion 113 thereof. The flutes 266 may be engaged by thethumb or finger of the user to rotate the proximal rotation knob 264360° in either direction 250 about the longitudinal axis “T”. The flutes266 of the proximal rotation knob 264 also provide a precise rotationalgrip. In one embodiment, the rotation knob 264 may comprise any suitablenumber of flutes 226 to provide a precise rotational grip. The proximalrotation knob 264 also comprises a plurality of radial projections 268formed on an interior portion 117 thereof. The radial projections 268may be formed of or may coated with a pliable, resilient polymericmaterial to securely frictionally engage the outer surface 115 of theultrasonic transducer 114. The radial projections 268 are dimensioned toform a snug or tight fit between the outer surface 115 of the ultrasonictransducer 114 and the proximal rotation knob 264. The ultrasonictransducer 114 is securely mechanically engaged to the ultrasonictransmission waveguide 164 portion of the elongated endoscopic shaftassembly 110 by the surface 210 and the stud 266 (FIG. 27). Accordingly,as the securely gripped proximal rotation knob 264 is rotated indirection 250 so are the ultrasonic transducer 114 and the entireelongated endoscopic shaft assembly 110. The proximal rotation knob 264provides a smooth, easy rotation of the ultrasonic transducer 114 andthe elongated endoscopic shaft assembly 110 using the thumb or finger,providing increased control to the surgeon. The ultrasonic transducer114 comprises a distal rim portion 272 with a circumferential ridge 274to engage a groove (not shown) formed within the inner wall of theproximal opening 156.

As previously discussed, in one embodiment, the proximal rotation knob264 is securely mechanically or frictionally engaged to the outerhousing of the ultrasonic transducer 114, which is mechanically engagedand acoustically coupled to the ultrasonic transmission waveguide 164(FIG. 14). For example, during a surgical procedure either the thumb orindex finger may be used to control the rotation of the ultrasonictransmission waveguide 164 shaft to locate the jaws of the end effectorassembly 112 in a suitable orientation. The middle and/or the otherlower fingers may be used to squeeze the trigger 120 and grasp tissuewithin the jaws. Once the jaws are located in the desired position andthe jaws are clamped against the tissue, the index finger can be used toactivate the toggle switch 132 to adjust the power level of theultrasonic transducer 114 and treat the tissue. Once the tissue has beentreated, the user the may release the trigger 120 and push outwardly inthe distal direction against the elongated trigger hook with the middleand/or lower fingers to open the jaws of the end effector assembly 112.This basic procedure may be performed without the user having to adjusttheir grip on the handle assembly 102.

In one embodiment, the proximal rotation knob 264 may be formed ofpliable, resilient, flexible polymeric materials including Versaflex®TPE alloys made by GLS Corporation, for example. Pliable, resilient, andflexible polymeric materials provide a secure and comfortable grip forthe user on the outer exterior portion of the proximal rotation knob264.

The proximal rotation knob 264 may be provided separately as anaccessory that may be packaged with the ultrasonic surgical instrument260 but not attached thereto. The proximal rotation knob 264 may be adoughnut or ring shaped single component formed of a substantiallypliable, resilient, and flexible polymeric material. The proximalrotation knob 264 may be inserted over the outer surface 115 of theultrasonic transducer 114, e.g., handpiece HP054 or HPBLUE, bothmanufactured by Ethicon Endo-Surgery. The radial projections 268 or“gripper ribs” formed on the interior portion 117 of the proximalrotation knob 264 securely engage the outer surface 115 diameter of theultrasonic transducer 114. The radial projections 268 may be formed ofthe same pliable, resilient, flexible polymeric material as the proximalrotation knob and define a diameter that is undersized relative to theouter surface 115 diameter of the ultrasonic transducer 114 to create afriction interference fit. The radial projections 268, however, do notengage the outer surface 115 diameter of the ultrasonic transducer 114so tightly as to make it difficult to assemble the components.

Once the proximal rotation knob 264 is located on the outside surface115 of the ultrasonic transducer 114, the transducer 114 is insertedthrough the proximal opening 156 of the instrument handle assembly 102the surface 210 is attached to the ultrasonic transmission waveguide 164by the stud 226 (FIG. 27). In other embodiments, the distal end of theultrasonic transducer 114 may be snapped onto the proximal end of theultrasonic transmission waveguide 164. Once the distal end of theultrasonic transducer 114 is located within the proximal opening 156 ofthe instrument handle assembly 102, the proximal rotation knob 264 isfree to rotate along with the ultrasonic transducer 114 and also is freeto slide longitudinally along the longitudinal axis T along the outersurface of the ultrasonic transducer 114 as the final threads of thestud 226 pull the ultrasonic transducer 114 forward in the proximaldirection towards the elongated endoscopic shaft assembly 110. After theultrasonic transducer 114 is completely assembled with a torque wrench,the proximal rotation knob 264 remains free to rotate, gripping theultrasonic transducer 114 and thereby rotating the entire elongatedendoscopic shaft assembly 110. The radial projections 268 frictionallysecure the outer surface of the ultrasonic transducer 114 with adequateforce to facilitate rotation of the elongated endoscopic shaft assembly110 even surgical conditions in which the exterior of the assembly orthe surgeon's gloves may be wet. After use the proximal rotation knob264 may be removed from the ultrasonic transducer 114 and eitherdiscarded or sterilized as described below.

FIG. 33 is a left side view of one embodiment of handle assembly 280 foran ultrasonic surgical instrument comprising both proximal and distalrotation assemblies. In one embodiment, the handle assembly 280comprises multiple rotation controls that may be accessible in amultitude of hand positions and suitable for a multitude of hand sizes.In one embodiment, the handle assembly 280 comprises dual rotationcontrols comprising the distal rotation control knob 134 and theproximal rotation control knob 264, as previously described. In oneembodiment, the handle assembly 280 comprises the distal rotationassembly 106 comprising the distal rotation knob 134 as previouslydescribed. In addition, the handle assembly 280 comprises the proximalrotation assembly 262 comprising the proximal rotation knob 264, aspreviously described.

FIG. 34 is an enlarged partial left perspective view of one embodimentof the handle assembly 280. As shown in FIG. 34, in one embodiment theproximal rotation knob 264 is ring-shaped and comprises an externalportion 113 and an interior portion 117. A plurality of flutes 266 areformed on an exterior surface 276 thereof. An internal surface 270 ofthe proximal rotation knob 264 comprises a plurality of radialprojections 268 to frictionally engage the outer contours of thehandpiece assembly of the ultrasonic transducer 114. As previouslydiscussed, the proximal rotation knob 264 may be formed of pliable,resilient, flexible polymeric materials, for example.

With reference to both FIGS. 33 and 34, the combination of dual rotationcontrols such as the proximal rotation assembly 262 and the distalrotation assembly 106 provide several benefits. The dual rotationcontrols render the handle assembly 280 better suited for users withsmall hands and reduce fatigue because it employs a natural movement ofthe thumb and/or fingers. If the finger tip rotation control of thedistal rotation knob 134 is difficult for a user with small hands toreach or the hand is located in an awkward position, the proximalrotation knob 264 provides the user with the option of using theproximal rotation knob 264 with their thumb to control the rotation ofthe elongated endoscopic shaft assembly 110.

The proximal rotation knob 264 and the distal rotation knob 134 may beused in combination to rotate the elongated endoscopic shaft assembly110 in opposite directions to ease stress and fatigue and also toprevent the cable 118 (FIGS. 1, 27, 28, 30) from winding around thehandpiece during use when only rotating in one direction. A right handeduser, for example, may employ the index finger to rotate the distalrotation knob 134 clockwise and employ the thumb to rotate the proximalrotation knob 264 counter clockwise to ease finger fatigue and preventthe cable 118 from tangling. Thus, as the user may readily switchbetween clockwise and counter clockwise rotation methods the cable 118becomes less tangled.

Additional benefits of the combination of the proximal rotation assembly262 and the distal rotation assembly 106 include simultaneousmulti-function use and ease of use in multiple hand positions. Theproximal rotation knob 264 enables rotation control of the end effectorassembly 112 with the thumb. This may be more comfortable and may allowfiner rotation control for small handed users. As previously discussed,in use, the proximal rotation knob 264 allows users to rotate theelongated endoscopic shaft assembly 110, control the jaws of theclamping mechanism of the end effector assembly 112, and activate therocker switches 132 simultaneously, which creates new uses for thedevice for experienced users. Providing the combination of distal andproximal rotation control lets the user select the most suitablerotation control depending on the position of the hand, e.g., neutral,supinated, pronated, awkward. Dual rotation is also less fatiguingbecause the natural movement of the finger and thumb are moved in adownward motion to effect rotation of control knobs. For example, theindex finger may apply a downward force against the distal rotation knob134 to rotate the elongated endoscopic shaft assembly 110 clockwise.Counter clockwise rotation of the distal rotation knob 134 requires anupward motion of the index finger, which may be awkward and slightlymore fatiguing. The thumb may apply a downward force against theproximal rotation knob 264 to rotate the elongated endoscopic shaftassembly 110 counter clockwise. Thus, counter clockwise rotation of theelongated endoscopic shaft assembly 110 mow requires a less awkward andfatiguing downward motion of the thumb motion. The dual rotation controlconfiguration gives the user the option of selecting between a fingerand a thumb to apply rotation to the elongated endoscopic shaft assembly110, which causes less compounding fatigue on one muscle group. Ineither case, the user has the option of selecting the controlconfiguration that is best suited for their physical attributes andstyles.

FIG. 35 illustrates a partial cut away view of one embodiment of ahandle assembly 281 for an ultrasonic surgical instrument. Withreference now to FIG. 35 and FIGS. 10-12 and 14, in one embodiment, atrigger 278 actuates the yoke 170, which is mechanically engaged to thecoupling elements 160 (FIG. 14) through various link members and theyoke 170. The coupling elements 160 are seated in the yoke 170 andlocked in place with the pin 162 (FIG. 14) provided through an opening171 in the yoke 170. The elongated endoscopic shaft assembly 110 iscoupled to the yoke 170 by way of the coupling elements 160. Thecoupling elements 160 mechanically engage the hub 163 located at theproximal end of the outer tubular sheath 142. For example, the hub 163of the outer tubular sheath 142 is retained in the yoke 170 by the pin162. The proximal end of the reciprocating tubular actuating member 144is mechanically engaged to the outer tubular sheath 142. Once lockedinto place, the yoke 170, the coupling elements 160 reciprocate withinopening 296 in directions 146A,B along the longitudinal axis T to effectmotion of the elongated endoscopic shaft assembly 110 in the samedirections. The motion is in response to the trigger 278. Accordingly,as the trigger moves in directions 121A,B the yoke 170, the couplingelements 160, and the elongated endoscopic shaft assembly 110 move incorresponding directions 146A,B. Thus, when the trigger 278 is squeezedin direction 121A the reciprocating tubular actuating member 144 movesin direction 146A to close the jaw elements of the end effector assembly112 in direction 148A as shown in FIGS. 10-12. The spring element 182restores the movable trigger in direction 121B when the squeezing forceis released. Accordingly, the yoke 170 and the reciprocating tubularactuating member 144 moves in direction 146B to open the jaws of the endeffector assembly 112 in direction 148B as shown in FIGS. 10-12.

In the illustrated embodiment, the hub 133 is located within the firstand second portions 102 a,b of the handle assembly 102. Acircumferential lip 344 is formed on a cylindrical sleeve portion 135and is received within a circumferential groove 346 formed in the distalend of the handle assembly 102. The circumferential lip 344 and thecircumferential groove 346 are dimensioned such that the cylindricalsleeve portion 135 is free to rotate within the circumferential groove346. The hub 133 is free to rotate within the circumferential groove 346when the first and second portions 102 a,b of the handle assembly 102are mated. The hub 133 is dimensioned and configured to receive thedistal rotation knob 134.

In one embodiment, the trigger 278 is mechanically engaged to first andsecond link members 282, 284 at a movable first pivot point 288. Themovable pivot point 288 is captured and moves within a first slot 294.At one end the first and second link members 282, 284 are pivotable atthe first pivot point 288. At the other end of the first link member282, the first link member is coupled to and is rotatable about a secondpivot point 290. At the other end of the second link member 284, thesecond link member 284 is coupled to and is pivotable about a thirdpivot point 292. At one end the third link member 286 is coupled to thesecond link member 284 at the third pivot point 292. At the other endthe third link member 286 is coupled to a fourth pivot 300, which iscaptured in and movable within a second slot 302. The yoke 170 iscoupled to the third link member 286 at the fourth pivot 300. The yoke170 is coupled to the coupling elements 160 and is part of thereciprocating yoke assembly 173. Accordingly, as the trigger 120 issqueezed in direction 121A, the first pivot point 288 moves downwardlywithin the first slot 294 pulling the second link member 284 and thethird link member 286 downwardly. As the third link member 286 is pulleddownwardly the yoke 170 is forced in direction directions 146A along thelongitudinal axis T closing the jaw elements of the end effectorassembly 112 in direction 148A. As the moveable trigger 120 is released,the spring element 182 forces the trigger 278 to move in direction 121B,which in turn forces the yoke to move in direction 146B along thelongitudinal axis A opening the jaw elements of the end effectorassembly 112 in direction 148B.

FIG. 36 is an enlarged partial view of one embodiment of the toggleswitch 132 and the yoke assembly 173 within a housing portion of thehandle assembly 281. The switch assembly 108 comprises the toggle switch132 implemented as a single component with a central pivot 304 insidethe handle assembly 102, to eliminate the possibility of simultaneousactivation. The toggle switch 132 rotates about the central pivot 304 asthe first projecting knob 132 a and the second projecting knob 132 b areactuated. The electrical element 172 b electrically energizes theultrasonic transducer 114 in accordance with the activation of the firstor second projecting knobs 132 a,b.

FIGS. 37-44 illustrate one embodiment of a handle assembly 310 for anultrasonic surgical instrument comprising both proximal and distalrotation assemblies. In the illustrated embodiment, the handle assembly310 comprises multiple rotation controls that may be accessible in amultitude of hand positions and for a multitude of hand sizes. In oneembodiment, the handle assembly 310 comprises a housing 314 formed of afirst portion 314 a (not shown) and a second portion 314 b. The handleassembly 310 comprises a proximal rotation assembly 312 and the distalrotation assembly 106 previously descried. The proximal rotationassembly 312 comprises a proximal rotation knob 334 and the distalrotation assembly 106 comprises the distal rotation knob 134.

In one embodiment, the handle assembly 310 comprises the distal rotationassembly 106 comprising the distal rotation knob 134 with the hub 133and the flutes 134 b as previously described. In addition, the handleassembly 310 comprises the proximal rotation assembly 312. The proximalrotation assembly 312 comprises the proximal rotation knob 334 attachedto a cylindrical hub 335 and a plurality of flutes 336 formed on anexterior portion thereof. The cylindrical hub 335 comprises acircumferential lip 332 adapted and configured to engage a correspondingcircumferential groove 328 formed in the housing 314. Thecircumferential lip 332 and the corresponding circumferential groove 328are dimensioned to enable the cylindrical hub 335 to rotate freelywithin the circumferential groove 328. The cylindrical hub 335 comprisesa plurality of slots 330 formed around a circumference thereof. Theproximal rotation knob 334 comprises a plurality of radial projections338 formed around a circumference thereof that correspond to the slots330. The proximal rotation knob 334 may be formed of pliable, resilient,flexible materials. A portion of the plurality of radial projections 338protrudes radially through the slots 330 to securely frictionally engagethe outer surface of the ultrasonic transducer 114.

In one embodiment, the handle assembly 310 comprises a trigger 322 and afixed handle 316. The fixed handle 316 is integrally associated with thehandle housing 314 and the trigger 322 is movable relative to the fixedhandle 316 as previously explained in detail in FIGS. 1-9 with respectto the operation of the ultrasonic surgical instrument 100. The fixedhandle 316 and the trigger 322 comfortably interface with the user. Thetrigger 322 moves in direction 121A toward the fixed handle 316 when asqueezing force is applied against the trigger 322. A spring element 182(FIG. 14) causes the trigger 322 to move in direction 121B and return toan original state when the user releases the squeezing force against thetrigger 322.

In one embodiment, the trigger 322 comprises an elongated trigger hook324 portion, which defines an aperture 126 between the elongated triggerhook 279 and the fixed handle 122. The aperture 126 is suitably sized toreceive one or multiple fingers therethrough.

In one embodiment, the trigger 322 also may comprise a contact portion322 a molded over the substrate of the trigger 322. The overmoldedportion 322 a provides a more comfortable contact surface for outwardcontrol of the trigger 322 in direction 121B. In one embodiment, theovermolded portion 322 a may be provided over a portion of the elongatedtrigger hook 324. For example, in the illustrated embodiment, theovermolded portion 322 a contact surface is provided over the distal andtop surfaces of the inner portion of the elongated trigger hook 324 toprovide cushion where it is needed by the user. The proximal surface ofthe elongated trigger hook 324 is not coated and remains bare substrate(e.g., polycarbonate) to enable the fingers to slide in and out of theaperture 126 more easily.

In other embodiments, the elongated trigger hook 324 may incorporate anovermolded component formed of pliable, resilient, flexible polymericmaterials including Versaflex® TPE alloys made by GLS Corporation, forexample. The elongated trigger hook 324 may incorporate the overmoldedportion 322 a to provide added comfort or a more secure grip to theuser. The overmolded contact portion 322 a formed on a top portion ofthe interior portion of the elongated trigger hook 324 alleviates edgepressure points on the fingers as they enters the aperture 126. The topportion of the trigger hook 324 may comprise a concave region 325 toallow additional clearance for the second projecting knob 132 b (notshown).

In one embodiment, the fixed handle 322 comprises a proximal contactsurface 317 and a grip anchor or saddle surface 318. The proximalcontact surface 317 is a normal pistol grip handle with no rings orapertures to be received in the palm of the user. The profile curve ofthe proximal contact surface 317 is contoured to accommodate or receivethe palm of the hand. To provide comfort and control while using theultrasonic instrument, the profile of the proximal contact surface 317is optimized to fit the natural anatomical contours in the valley of thecenter of the palm and base of the thumb. In one embodiment, the saddlesurface 318 provides a grip anchor, which contributes to the stabilityof control of the handle assembly 310. The location of the saddlesurface 318 determines the range of motion for the fingers and thumb toaccess the proximal rotation knob 334, the distal rotation knob 134, theelongated trigger hook 324, and the power activation toggle switch fromthe proximal contact surface 317 of the fixed handle 316.

A stabilization tail 320 that may be in contact with the portion of thehand located between the thumb and the index finger adds stability whenthe handle provides added control to the handle assembly 310. Thestabilization tail 320 provides an extended return area to allowproximal weight of the ultrasonic surgical instrument to rest on top ofthe hand of the user. This provides a greater sense of stability,comfort, and control in the saddle surface 318 of the handle assembly310.

FIGS. 45-52 illustrate one embodiment of the proximal rotation assembly312 shown in FIGS. 37-44. In the illustrated embodiment, the proximalrotation assembly 312 comprises the proximal rotation knob 334 insertedover the cylindrical hub 335. The proximal rotation knob 334 comprises aplurality of radial projections 338 that are received in correspondingslots 330 formed on a proximal end of the cylindrical hub 335. Theproximal rotation knob 334 defines an opening 348 to receive the distalend of the ultrasonic transducer 114. The radial projections 338 areformed of a soft polymeric material and define a diameter that isundersized relative to the outside diameter of the ultrasonic transducer114 to create a friction interference fit when the distal end of theultrasonic transducer 114. The polymeric radial projections 338 protruderadially into the opening 348 to form “gripper” ribs that firmly gripthe exterior housing of the ultrasonic transducer 114. Therefore, theproximal rotation knob 334 securely grips the ultrasonic transducer 114.

The distal end of the cylindrical hub 335 comprises a circumferentiallip 332 and a circumferential bearing surface 340. The circumferentiallip engages the groove 328 formed in the housing 314 and thecircumferential bearing surface 340 engages the housing 314, as shown inFIGS. 38 and 40, for example. Thus, the cylindrical hub 335 ismechanically retained within the two housing portions 314 a (not shown)and 314 b of the housing 314 as shown in FIGS. 37-44. Thecircumferential lip 332 of the cylindrical hub 335 is located or“trapped” between the first and second housing portions 314 a,b and isfree to rotate in place within the groove 328. The circumferentialbearing surface 340 bears against interior portions of the housing 314to assist proper rotation. Thus, the cylindrical hub 335 is free torotate in place within the housing 314. The user engages the flutes 336formed on the proximal rotation knob 334 with either the finger or thethumb to rotate the cylindrical hub 335 within the housing 314.

In one embodiment, the cylindrical hub 335 may be formed of a durableplastic such as polycarbonate. In one embodiment, the cylindrical hub335 may be formed of a siliconized polycarbonate material. In oneembodiment, the proximal rotation knob 334 may be formed of pliable,resilient, flexible polymeric materials including Versaflex® TPE alloysmade by GLS Corporation, for example. The proximal rotation knob 334 maybe formed of elastomeric materials, thermoplastic rubber known asSantoprene®, other thermoplastic vulcanizates (TPVs), or elastomers, forexample. The embodiments, however, are not limited in this context.

FIGS. 53-57 illustrate one embodiment of the distal rotation assembly106 shown in FIGS. 37-44. In the illustrated embodiment, the distalrotation assembly 106 is formed of a hub 133 comprising a flutedrotation knob 134 formed thereon. The hub 133 comprises a cylindricalsleeve portion 135, which is received within the distal housing portion(e.g., first and second housing portions 102 a,b and first and secondhousing portions 314 a,b). A pair of openings 342 are formed in thecylindrical sleeve portion 135 to receive the pin 162 to retain the hubportion 163 of the outer tubular sheath 142 (FIG. 14). A circumferentiallip 344 is formed on the cylindrical sleeve portion 135 and is receivedwithin a corresponding groove 346 formed in the distal end of the handleassembly 102. The circumferential lip 344 and the circumferential groove346 are dimensioned such that the cylindrical sleeve portion 135 is freeto rotate within the circumferential groove 346 when the first andsecond portions 102 a,b of the handle assembly 102 are mated.

The hub 133 is located or rotatably “trapped” between the left and righthousing portions 102 a,b and is free to rotate in place within thegroove 346. The fluted rotation knob 134 is formed over the hub 133employing using well known overmolding techniques or other techniques.The fluted rotation knob 134 also may be mechanically or frictionallyengaged with the hub 133. The flutes are defined by raised ridges orribs 134 b and concave regions 134 b formed therebetween. The hub 133may be formed of a durable plastic such as polycarbonate. In oneembodiment, the hub 133 may be formed of a siliconized polycarbonatematerial. The fluted rotation knob 134 may be formed of a resilient,pliable polymeric material such as Santoprene or Versaflex, for example.The embodiments are not limited in this context.

Turning now to FIGS. 58-69, it has long been a challenge to create ahandle design in terms of size, shape, and location of controlinterfaces that is “ideal” for everyone. The very large disparity ofanthropometrics from 5th percentile small female to 95th percentilelarge male surgeon from traditionally creates ergonomic challenges forusers at the extreme ends of the spectrum. Although provision ofmultiple different handle sizes has been considered for some time, thereis a general within the hospital community to carry fewer inventories,thus there still would exist the risk that a certain size handle wouldnot be available for a particular individual at a particular hospital.Thus, various embodiments provide a handle design for multipleinstruments to more optimally ergonomically interface in terms ofcomfort and control for a large variety of hand sizes.

FIG. 58 is a right side perspective view of one embodiment of the handleassembly 102 for an ultrasonic surgical instrument suitable to receive ahandle adapter. The handle assembly 102 comprises a trigger assembly104, a distal rotation assembly 106, and a switch assembly 108. Thehandle assembly 102 comprises a trigger 120 and a fixed handle 122. Thefixed handle 122 is integrally associated with the handle assembly 102and the trigger 120 is movable relative to the fixed handle 122 asexplained in more detail below with respect to the operation of theultrasonic surgical instrument 100. The fixed handle 122 and the trigger120 comfortably interface with the user. The fixed handle 122 comprisesproximal contact surface 128 and a grip anchor or saddle surface 130.The stabilization tail 131 may be in contact with the portion of thehand located between the thumb and the index finger and adds stabilityto the handle assembly 102. The trigger 120 comprises the elongatedtrigger hook 124, which defines the aperture 126 between the elongatedtrigger hook 124 and the fixed handle 122. The handle assembly 102 issuitable to receive a handle adapter as described below.

FIG. 59 is a right side perspective view of one embodiment of the handleassembly 102 and one embodiment of a handle adapter 400. The handleadapter 400 comprises a body that defines an opening 402 to receive thefixed handle 122, the proximal contact surface 128, the saddle surface130, and the stabilization tail 131. The interior of the opening 402defines a contour that is the inverse shape of the proximal contactsurface 128, the saddle surface 130, and the stabilization tail 131 suchthat the adapter fits snugly against the proximal contact surface 128,the saddle surface 130, and the stabilization tail 131. An externalcontour of the opening 402 defines a new fixed handle 122′, a proximalcontact surface 128′, a saddle surface 130′, and a stabilization tail131′ portion that is substantially similar to the proximal contactsurface 128, the saddle surface 130, and the stabilization tail 131originally formed on the fixed handle 122. The thickness or width of thehandle adapter 400 is ergonomically adapted to the size of the hand ofthe user. The handle adapter 400 may be formed of a single-piececomponent and may be packaged to be used in conjunction with anultrasonic surgical instrument that may be sized for average-to-smallerhands. The handle adapter 400 may easily be removably attached to thehandle assembly 102 of the ultrasonic surgical instrument 100 to expandor enlarge the size of the grip to accommodate larger hands. Prominentgraphics may be provided on the instrument package and on the handleadaptor 400 to communicate the intended use of the handle adapter 400.The overall appearance of the handle adaptor 400 makes its functionreadily understandable.

FIG. 60 is a right side perspective view of one embodiment of the handleassembly 102 comprising the handle adapter 400 attached thereto. In oneembodiment, the handle adaptor 400 may be formed as a press-fitcomponent that fits “like a glove” over the main grip portion of thefixed handle 122. The handle adapter 400 is frictionally held in placeduring use. The handle adaptor 400 is easily removable from the handleassembly 102. The handle adaptor 400 may be formed of a variety ofmaterials including a range of elastomers with varying durometers, rigidpolymers, and pliable polymers, among others. In one embodiment, thesurface area of the adapter may comprise a wide range of texture andgrip detailing over the contours of the geometry of the handle adapter400. In another embodiment, the handle adapter 400 may comprisevariable-size feature embedded as part of the main handle—wherein alock/release control enables the proximal portion of the handle adapter400 to extend or compress, to allow substantially infinite adjustmentfor a particular hand size.

FIGS. 61-69 illustrate one embodiment of a handle adapter 410 comprisingsnap-button features suitable for attaching to a handle assembly of anultrasonic surgical instrument. The handle adapter 410 defines anopening 412 adapted and configured to receive a fixed handle portion ofa handle assembly of a surgical instrument. The handle adapter 410defines the fixed handle 122′, the proximal contact surface 128′, thesaddle surface 130′, and the stabilization tail 131′ portions of thehandle assembly that are more suitably ergonomically adapted to the handof the user. The handle adapter 410 may be formed of a single-piececomponent and may be packaged to be used in conjunction with anultrasonic surgical instrument that may be sized for average-to-smallerhands. The handle adapter 410 may be easily removably attached to thehandle assembly 102 (FIGS. 58-60) of the ultrasonic surgical instrument100, to expand the size of the grip to accommodate larger hands.Prominent graphics may be provided on the package and on the handleadaptor 410 to communicate the intended use of the handle adapter 410.The overall appearance of the handle adaptor 410 makes its functionreadily understandable.

In one embodiment, the handle adaptor 410 may be formed as a press-fitcomponent that fits “like a glove” over the main grip portion of thefixed handle. The interior portion of the handle adapter 410 comprisessnap button features 404 that may be received in corresponding openings(not shown) defined on the fixed handle 122 portion of the handleassembly 102 (FIGS. 58-60). The snap button features 404 mechanicallyattach the handle adapter 410 to the fixed handle 122 and hold thehandle adapter 410 in place during use. The handle adaptor 410 is easilyremovably attached from the fixed handle 102 of the handle assembly 102.The handle adaptor 410 may be formed of a variety of materials includinga range of elastomers with varying durometers, rigid polymers, andpliable polymers, among others. In one embodiment, the surface area ofthe adapter may comprise a wide range of texture and grip detailing overthe contours of the geometry of the handle adapter 410. In anotherembodiment, the handle adapter 410 may comprise variable-size featureembedded as part of the main handle—wherein a lock/release controlenables the proximal portion of the handle adapter 410 to extend orcompress, to allow substantially infinite adjustment for a particularhand size.

Turning now to FIGS. 70-87, the multi-function capability of theultrasonic surgical instrument 100, particularly the laparoscopicultrasonic surgical instrument 100 may create certain ergonomicchallenges for the user to comfortably access and operate the multiplefunctions and controls of the instrument. These include the ability tocomfortably actuate the jaws of the clamping mechanism of the endeffector assembly 112 and to activate the hand control buttons such asthe toggle switch 132. The user must be able to control the openingmotion in direction 148B (FIGS. 3 and 11) of the end effector assembly112 to facilitate spreading dissection, for example. A spreadingdissection using laparoscopic instruments requires a reaction surface toallow the user to manipulate the instrument in multiple directions.Using an outward movement of the thumb to oppose the “anchored” fingersprovides for an adequate outward motion to accomplish this task. Theultrasonic surgical instruments previously described include a handleassembly comprising a fixed handle, either integrally formed with thehandle assembly or removably attached thereto. The pistol gripincorporates a trigger that may be pushed outward with the index andmiddle finger while maintaining grip on the handle stock. This outwardmotion action, however, may create fatigue and hand strain during aspreading or fine dissection procedures. Nevertheless, this outwardmotion is necessary during spreading or fine dissection laparoscopicprocedures. The pistol grip handle, which is preferred by many surgeonsfor its comfort, ease, and stability of the grip style, may not beoptimal for ease of dissection. For dissections, many surgeons prefer ascissor-like loop or ring type grip. Accordingly, various embodimentsdescribed below provide an ultrasonic surgical instrument comprising ahandle assembly that may be adapted and configured with a scissor-likeloop or ring type grip. The scissor-like loop or ring type grip may beformed integrally with the handle assembly or may be implemented in theform of a removably attached loop adapter.

FIG. 70 illustrates one embodiment of a handle assembly 102 of anultrasonic surgical instrument comprising a loop handle adapter assembly418. The loop handle adapter assembly 418 comprises a loop handleadapter 420 and a resilient, pliable, and/or flexible element 428attached thereto. The loop handle adapter 420 adapts or converts thefixed handle 122 portion of the handle assembly 102 from a conventionalpistol grip to a scissor-like loop or ring type grip comprising a pairof loops defined by apertures 422. The loop handle adapter 420facilitates the use of a more controlled manipulation of the handleassembly 102 outward motion during spreading or fine dissectionlaparoscopic procedures, for example. The loop handle adapter 420 isadapted and configured to removably attach to the fixed handle 122portion of the handle assembly 102. The loop handle adapter 420comprises one or more snap features 424 (FIG. 71) and one or more posts426 (FIGS. 71, 77, 79) formed integrally on an interior surface 425(FIG. 71) of the loop handle adapter 420. The one or more snap features424 (FIGS. 71-73, 77-80) removably engage the loop handle adapter 420 tothe fixed handle 122 of the handle assembly 102. The one or more posts426 align the loop handle adapter 420 with the fixed handle 122. In oneembodiment, the elongated trigger hook 124 may comprise a plurality ofnubs 127 formed of pliable, resilient, flexible polymeric materialsincluding Versaflex® TPE alloys made by GLS Corporation, for example.

The apertures 422 are defined by two curved elements 430 a,b (430 b isshown in FIGS. 71-79) and a proximal contact element 432 that are joinedat a base portion 436 and at an upper saddle surface 438. The two curvedelements 430 a,b and the proximal contact element 432 also define astabilization tail 434. The aperture 422 is suitable to receive thethumb of the user therethrough to enable the user to more easily andcomfortably manipulate the handle assembly 102 or apply a retractingforce. The user may insert the thumb through the aperture 422 and engagethe proximal contact surface 128 and the saddle surface 130 of the fixedhandle 122, which remains exposed to engage the hand. The loop handleadapter 420 also may be employed as an adapter for larger handed userswho wish to use the handle assembly 102 with a conventional pistol grip.The proximal contact element 432, the upper saddle surface 438, and thestabilization tail 434 provide a larger span to accommodate a largerhand to more comfortably reach to controls such as the trigger 120 andthe switch assembly 108. The loop handle adapter 420 also defines alower saddle surface 442 to accommodate the lower base portion of thethumb.

FIGS. 71-80 illustrate one embodiment of the loop handle assembly 418.As illustrated, the loop handle assembly 418 comprises a loop handleadapter 420 coupled to a flexible element 428. The loop handle adapter420 comprises the two curved elements 430 a,b that define a radius “r”relative to an axis 435. The two curved elements 430 a,b join theproximal contact element 432 to define the aperture 422, the uppersaddle surface 438, the stabilization tail 434, and the lower saddlesurface 442. Functionally, the aperture 422 enables the user to employthe thumb to assist in the manipulation of the handle assembly 102. Theupper saddle surface 438 and the stabilization tail 434 perform the samefunctions as discussed above with reference to FIGS. 25 and 26. The post426 may be formed near a base portion 436 of the loop handle adapter 420and the two snap features 424 that snap into corresponding indentationsor openings (not shown) formed on the sides of the fixed handle 122 maybe formed near the saddle surface 130 region of the handle assembly 102.This allows a quick secure removably mounted connection that can beeasily removed if necessary. The flexible element 428 comprises aplurality of ribs 440 to provide resilience and to reduce the pressureto the sides of the thumb. The flexible element 428 also comprises alower saddle surface 442 a to engage the lower saddle surface 442 of theloop handle adapter 420. The loop handle adapter 420 also provides acontact surface 444 to engage the thumb of the user. In one embodiment,the resilient, pliable, flexible element 428 may be attached or moldedto the proximal contact element 432 of the loop handle adapter 420. Theloop handle adapter 420 may be formed as a single component with theflexible element 428 or they may be formed as separate components. Theloop handle adapter 420 may be formed of a durable plastic such aspolycarbonate and the flexible element 428 may be formed of softerpliable, resilient, flexible polymeric materials including Versaflex®TPE alloys made by GLS Corporation, for example. The flexible element428 may be molded over the loop handle adapter 420 or may be formedseparately and then attached thereto.

FIGS. 81-82 illustrate left and front perspective views of oneembodiment of the loop handle adapter 420. FIG. 82 shows an internalbody portion 432 a of the proximal contact element 432 to receive theflexible element 428.

FIGS. 83-87 illustrate one embodiment of a flexible element 428 portionof the loop handle assembly 418 shown in FIGS. 71-80. The flexibleelement 428 may be formed of pliable, resilient, flexible polymericmaterials including Versaflex® TPE alloys made by GLS Corporation, forexample. The flexible element 428 is formed of a single elementcomprises a contact surface 444, a plurality of ribs 440, and a saddlesurface contact surface 442 b adapted to engage the lower saddle potion442 of the loop handle adapter 420 shown in FIGS. 81-82. The saddlesurface 442 a may be engaged by the thumb or hand of the user. Theflexible element 428 also comprises a channel 446 to receive theinternal body portion 432 a of the proximal contact element 432. Asshown, the channel 446 expands to a larger channel 448 to accommodatethe lower saddle surface 442 of the of the loop handle adapter 420.

Turning now to FIGS. 88-90, several factors can be applied to assess theviability of the ergonomics of a particular design for a medicalinstrument. Aside from comfort, one objective factor is the ability tocontrol the working end of the handle assembly 102 with a suitabledegree of control needed to accomplish a surgical task with ease. To theextent that this control is achieved emanates first from the inherentstability of the handle assembly 102 in the hand of the user, and secondfrom the ease of the finer motions required to manipulate the specificinstrument controls. Design efforts include balancing the ability toachieve overall stability in the hand while facilitating appropriateaccess to the fine controls.

In various embodiments, the handle assembly 102 may be stabilized byadapting a variety of pistol grips. The various embodiments of thepistol grips provide several points of fixation on the hand:

(1) a squeezing force between the thumb and index fingers resting in theweb of the joint;

(2) a grasping force between the thumb and index finger; and

(3) a gripping force between the fingers and the palm while activatingthe trigger 120.

There exists optimal locations between the various controls on thedistal end of the handle assembly 102 that may be employed as points offixation. These include locations between the distal rotation knob 134,the toggle switch 132, the trigger 120, and the saddle surface 130,which rests on the thumb/index web of the joint of the hand. Someembodiments vary the width of the fixed handle 122 portion toaccommodate various hand sizes including varying the basic distancebetween the saddle surface 130 and the front controls. Other embodimentsvary the length of the fixed handle 122 to situate the end of the fixedhandle 122 against the palm. Still, other embodiments vary the angle ofthe fixed handle 122.

FIG. 88 illustrates one embodiment of a handle assembly 350 comprising acurved stability projection 352 (e.g., bump) formed at the rear orproximal location of the fixed handle 122. The curved stabilityprojection 352 provides an intimate contact surface between the fixedhandle 122 and the length of the palm of the hand to stabilize thehandle assembly 350. One point of fixation may be achieved by locatingthe saddle surface 130 of the handle assembly 350 at the thumb/indexfinger web of the joint of the hand as described above. A second area offixation is achieved by locating the curved stability projection 352 atthe rear of the fixed handle 122 to achieve contact between the handleassembly 350 and the center of the palm of the hand. In this manner, alarge area of contact is achieved in the center of the palm instead of asmall area at the base 354 of the fixed handle 122. The saddle surface130 of the handle assembly 350 is maintained without varying the optimumgrip span 356. The contact area may be achieved regardless of hand sizebecause of the broad curve of the curved stability projection 352.Providing two fixation points mechanically prevents the distal tip ofthe instrument from rotating about the saddle surface 130 with littleactual applied hand force, thus freeing up the digits of the hand toactuate the finer controls such as the distal rotation knob 134, thetoggle switch 132, and the trigger 120, for example. The curvedstability projection 352 may be formed integral to the length of thefixed handle 122 of the handle assembly 352, or may be formed by addinga softer, more conforming material to the fixed handle 122.

FIGS. 89 and 90 illustrate one embodiment of a handle assembly 360comprising protrusions 362 formed on both sides of the fixed handle 122.The protrusions 362 provide additional fixation points and ergonomicbenefits to handle assemblies described herein. In one embodiment, theprotrusions 362 enable additional control of the handle assembly 360during dissection or other types of surgical procedures. Some users mayexperience fatigue and reduced control when using certain ultrasonicsurgical instruments while operating the instrument. One factor that maylead to fatigue and reduced control is pinching the fixed handle 122between the thumb and index finger of the user while pushing outward onthe elongated trigger hook 124 with their other fingers. Accordingly,the ear-like protrusions 362 attached or formed to both sides of thehandle assembly 360 provide an edge or surface contact area for the userto engage with the thumb. The protrusions 362 stabilize of the handleassembly 360 during surgical procedures, such as dissecting, andalleviate some of the fatigue due to squeezing the handle assembly 360between the thumb and index finger. The protrusions 362 may comprise aridge 364 to allow for the thumb to counteract the extension force indirection 366 with and opposing surface instead of relying on frictionand compression from squeezing the thumb and the index finger. Theprotrusion may be textured or overmolded with a compliant material toimprove the grip and feel when the user is wearing surgical gloves. Italso may be contoured so as not to create any sharp or uncomfortableedges that the thumb or index finger can rest against.

Various embodiments comprising blades and clamp arm assembliescomprising proximal tissue pad segments, distal tissue pad segments, andtissue pad insert segments have been described. The pivotal movement ofthe clamp arm assemblies with respect to the blades may be affected bythe provision of a pair of pivot points on the clamp arm portion of theclamp arm assembly that interfaces with an ultrasonic surgicalinstrument via weld pin fastening or other fastening means. The tissuepad segments may be attached to the clamp arm by mechanical meansincluding, for example, rivets, glues, adhesives, epoxies, press fittingor any other fastening means known in the art. Furthermore, the tissuepad segments may be removably attached to the clamp arm by any knownmeans.

In various embodiments, the clamp arm may comprise a T-shaped slot foraccepting a T-shaped flange of a proximal tissue pad segment, a distaltissue pad segment and a tissue pad insert segment. In variousembodiments, a single unitary tissue pad assembly may comprise theproximal tissue pad segment, the distal tissue pad segment and thetissue pad insert segment, and further comprise a T-shaped flange forreception in a T-shaped slot in the clamp arm assembly. Additionalconfigurations including dove tailed-shaped slots and wedge-shapedflanges are contemplated. As would be appreciated by those skilled inthe art, flanges and corresponding slots have alternative shapes andsizes to removably secure the tissue pad segments to the clamp arm.

A method for replacing the proximal tissue pad segment, the distaltissue pad segment and/or the tissue pad insert segment include one ormore of the steps of: a) disengaging the clamp arm assembly from theultrasonic surgical instrument; b) removing at least one of the tissuepad segments from the clamp arm; c) inserting at least one new orreconditioned tissue pad segment into the clamp arm; and d) engaging theclamp arm assembly with the ultrasonic surgical instrument. In thisremoval and replacement process, the new or reconditioned proximaltissue pad segment, distal tissue pad segment and tissue pad insertsegment may be multiple separate segments or of unitary construction.

Another method for replacing the proximal tissue pad segment, the distaltissue pad segment and/or the tissue pad insert segment include one ormore of the steps of: a) opening flanges on the clamp arm; b) removingat least one of the tissue pad segments from the clamp arm; c) insertingat least one new or reconditioned tissue pad segment into the clamp arm;and d) closing flanges on the clamp arm. In this removal and replacementprocess, the new or reconditioned proximal tissue pad segment, distaltissue pad segment and tissue pad insert segment may be multipleseparate segments or of unitary construction.

Preferably, the various embodiments described herein will be processedbefore surgery. First, a new or used instrument is obtained and ifnecessary cleaned. The instrument can then be sterilized. This can bedone by any number of ways known to those skilled in the art includingbeta or gamma radiation, ethylene oxide sterilization, and/or steam, forexample. In one sterilization technique, the instrument is placed in aclosed and sealed container, such as a plastic or TYVEK® bag. Thecontainer and instrument are then placed in a field of radiation thatcan penetrate the container, such as gamma radiation, x-rays, orhigh-energy electrons sterilization. The sterilization kills bacteria onthe instrument and in the container. The sterilized instrument can thenbe stored in the sterile container. The sealed container keeps theinstrument sterile until it is opened in the medical facility.

Although various embodiments have been described herein, manymodifications and variations to those embodiments may be implemented.For example, different types of end effectors may be employed. Inaddition, combinations of the described embodiments may be used. Forexample, a concave blade tip may be coated with a hydrophobic material.Also, where materials are disclosed for certain components, othermaterials may be used. The foregoing description and following claimsare intended to cover all such modification and variations.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

1. A surgical instrument comprising: a trigger configured to be actuatedby a proximally directed force and by a distally directed force, andwherein the trigger comprises: a proximal trigger portion having a firstlength; and a distal trigger hook comprising a distal portion having asecond length, wherein the second length is less than the first length,and wherein the distal trigger hook is coupled to the proximal triggerportion.
 2. The surgical instrument of claim 1, further comprising anactuation switch positioned upwardly from the trigger, wherein theactuation switch is actuatable in a substantially proximal direction. 3.The surgical instrument of claim 1, further comprising a shaft rotationassembly for rotating a shaft of the surgical instrument about alongitudinal axis.
 4. The surgical instrument of claim 3, wherein theshaft rotation assembly comprises first and second rotation knobs,wherein the first rotation knob is positioned at a handle portion of thesurgical instrument proximately from the shaft and wherein the secondrotation knob is positioned at the handle portion of the surgicalinstrument proximately from the first rotation knob.
 5. The surgicalinstrument of claim 3, wherein the shaft rotation assembly comprises afluted rotation knob.
 6. The surgical instrument of claim 1, furthercomprising: an actuation switch positioned upwardly from the trigger,wherein the actuation switch is actuatable in a substantially proximaldirection; and a shaft rotation assembly for rotating a shaft of thesurgical instrument about a longitudinal axis, wherein the shaftrotation assembly is positioned upwardly from the actuation switch. 7.The surgical instrument of claim 6, wherein the actuation switchcomprises a rocker switch, wherein actuation of a first side of therocker switch causes the surgical instrument to operate according to afirst mode and actuation of a second side of the rocker switch tooperate according to a second mode.
 8. The surgical instrument of claim1, further comprising a housing, wherein the trigger is movably coupledto the housing.
 9. The surgical instrument of claim 8, wherein thehousing defines a body portion extending along a distally-directedlongitudinal axis and a handle portion extending downwardly from thebody portion and away from the longitudinal axis.
 10. The surgicalinstrument of claim 9, wherein the handle portion defines a saddlesurface on a proximate portion of the handle portion adjacent the bodyportion for receiving a clinician's hand at a web portion of the handbetween a thumb and an index finger of the hand and a contact surfacebelow the saddle surface configured to be received in a palm of aclinician's hand, wherein the contact surface defines a convex curvatureextending proximally from the handle portion.
 11. The surgicalinstrument of claim 10, wherein the housing comprises a removableadapter positioned over the handle portion to change a radius of theconvex curvature of the contact surface, and wherein the removableadapter comprises a loop element positioned proximally from the handleportion such that a clinician's hand is receivable between the handleportion and the loop element.
 12. The surgical instrument of claim 1,wherein a ratio of the first length over the second length is equal toabout 1.25.
 13. The surgical instrument of claim 1, wherein the firstlength is about 2.5 inches.
 14. The surgical instrument of claim 1,wherein a distance between the proximal trigger portion and the distalportion is at least about 0.65 inches.
 15. The surgical instrument ofclaim 1, wherein the proximal trigger portion is positioned to receivethe proximally directed force from a clinician's middle finger, ringfinger and little finger, and wherein the distal portion is positionedto receive a distally directed force from the clinician's middle fingerand ring finger.
 16. A surgical instrument comprising: a housingdefining a body portion extending along a distally-directed longitudinalaxis and a handle portion extending downwardly from the body portion andaway from the longitudinal axis; a trigger coupled to the housing andalternately actuatable in a substantially proximal direction relative tothe handle portion and in a substantially distal direction relative tothe handle portion, wherein the trigger comprises: a proximal memberextending downwardly from the body portion by a first distance; and adistal member extending downwardly from the body portion by a seconddistance, wherein the second distance is less than the first distance,and wherein the proximal member and the distal member define an aperturetherebetween.
 17. The surgical instrument of claim 16, wherein thehandle portion is fixed.
 18. The surgical instrument of claim 16,wherein the trigger also comprises an upper portion coupling theproximal member and the distal member to one another.
 19. The surgicalinstrument of claim 16, wherein a ratio of the first distance over thesecond distance is equal to about 1.25.
 20. The surgical instrument ofclaim 16, wherein the first distance is about 2.5 inches.
 21. Thesurgical instrument of claim 16, wherein a distance between the proximalmember and the distal member is at least about 0.65 inches.
 22. Thesurgical instrument of claim 21, wherein the housing further defines acontact surface and a stabilization tail.
 23. The surgical instrument ofclaim 22, wherein the stabilization tail extends proximally from atleast one of the handle portion and the body portion.
 24. A hand-heldsurgical instrument comprising: an end effector, the end effectorcomprising: an ultrasonic blade; and a clamp arm pivotable towards theultrasonic blade; an elongate shaft extending along a longitudinal axis,wherein the end effector is positioned at about a distal portion of theelongate shaft; a housing coupled to the elongate shaft at a proximalportion of the elongate shaft, the housing defining a body portionextending proximally from the elongate shaft, and a handle portionextending downwardly from the body portion and away from thelongitudinal axis; and a trigger to control the clamp arm, the triggercoupled to the housing and alternately actuatable in a substantiallyproximal direction relative to the handle portion and in a substantiallydistal direction relative to the handle portion, wherein the triggercomprises: a proximal member extending downwardly from the body portionby a first distance; and a distal member extending downwardly from thebody portion by a second distance, wherein the second distance is lessthan the first distance, and wherein the proximal member and the distalmember define an aperture therebetween.
 25. The surgical instrument ofclaim 24, wherein the clamp arm is coupled to the distal portion of theelongate shaft.
 26. The surgical instrument of claim 24, furthercomprising an actuation switch positioned on a distal portion of thehousing below the elongate shaft and above the trigger, wherein theactuation switch is actuatable in a substantially proximal direction toactivate the ultrasonic blade.
 27. The surgical instrument of claim 24,wherein a ratio of the first distance over the second distance is equalto about 1.25.
 28. The surgical instrument of claim 24, wherein thefirst distance is about 2.5 inches.
 29. The surgical instrument of claim24, wherein a distance between the proximal member and the distal memberis greater than about 0.65 inches.
 30. The surgical instrument of claim24, further comprising a rotation assembly coupled to the elongate shaftsuch that rotation of the rotation assembly about the longitudinal axiscauses rotation of the elongate shaft about the longitudinal axis.